Hospital Acquired pneumonia Flashcards
What is hospital-acquired pneumonia
an acute infection of the pulmonary parnenchyma with development of the pneumonia at least 48 hours after hospitalization
What is ventilator-acquired pneumonia
pneumonia that develops after 48 hours of a patient being intubated
What diseases can impair lung defenses
Guillian Barre, Multiple Sclerosis, Seizures, Cystic Fibrosis, Myocardial Infaction, Stroke, HIV
What are factors that can lead to a patient acquiring hospital acquired pneumonia
Medication Altering gastric emptying and pH, invasive devices with biofilm, prior antibioitics, host factors (immunosuppression, burns)
T/F: Gram negative bacteria are the most likely to cause hospital-acquired pneumonia
True
What are negative bacteria that cause hospital-acquired pneumonia
Pseudomonas aeruginosa, enterobacter sp., klebsiella pneumoniae, escherichia coli, hemophilus influenzae, acinetobacter, stenotrophamonas maltophilia
What are gram positive bacteria that cause hospital-acquired pneumonia
Staphylococcus aureus, streptococcus pneumniae
What are general risk factors for acquring hospital acquired pneumonia
Mechanical ventillation, length of hospitalization, prior antibiotic use, age greater than 70, H2 blocker use, bactermia
What are the risk factors for multi-drug resistant pathogens
Antimicrobial therapy in the preceding 90 days for both VAP and HAP, greater than 5 days of hospitalization prior to VAP, Septic shock (sepsis) at the time of VAP. Acute respiratory distress syndome (ventilated) preceding VAP, Acute renal replacement therapy (dialysis) prior to VAP
What should be done if the patient has risk factors for multi-drug resistant pathogens
Give 2-3 drugs
What are new signs and symptoms that could lead to a diagnosis of HAP/VAP
Fever, increased WBC, increased sputum production
When should MRSA be covered for in HAP/VAP
Risk factors for multi-drug resistant pathogens, unit where the patient is residing has a greater than 10% incidence of MRSA, prevalence of MRSA knoknown and/or patient is tntubated/ and/or in septic shock
What are the antibiotic choices for covering MRSA
Vancomycin 15-20 mcg/ml OR Linezolid 600 mg IVPB every 12 hours
If there are no MRSA risk factors what antibiotics can be used emperically used
Piperacillin-tazobactam, cefepime, levofloxacin, imipenem or meropenem
If MSSA is isolated what antibiotics should be used
Nafacillin 2 grams IVPB every 4 hours OR oxacillin 2 gram IVPB every 4 hours OR Cefazolin 2 grams every 8 hours
When should 2 drugs for pseudomonas or resistant gram negative organisms be used
Risk factor for multi-drug resistance, unit where patient is residing has a greater than 10% incidence of resistance to the antibiotics being considered for monotherapy, prevalence not known and intubated and/or the patient has cystic fibrosis or bronchteasis
What are the first group of antibiotics that can be used when trying to cover for pseudomonas or resistant gram negative organisms
Antipseudomonnal cephalosporin: Ceftazadime 2 grams IVPB every 8 hours/Cefipime 2 grams IVPB every 8 hours OR
Antipseudomonal carbapenem: Imipenen 500 mg IVPB every 6 hours/ Meropenem 1 gram IVPB every 8 hours OR
Beta-lactam/Beta-lactamase inhibitor: piperacillin/tazobactam 4.5 grams IVPB every 6 hours OR
Monobactam: Aztreonam 2 grams IVPB every 8 hours
What is the second group of antibiotics that can be used when trying to cover for pseudomonas or resistant gram negative organisms
Antipseudmonal fluroquinolone: Levofloxacin 750 mg IVPB every day/ Ciprofloxacin 400 mg IVPB every 8 hours OR
Aminoglycosides: Gentamicin/Tobramycin?Amikacin OR
Polymixin: Colistin 5mg/kg first does then 2.5 mg/kg IVPB every 12 hours or polymixin B 2.5-3mg/kg/day IVP divded into 2 daily doses
If there is no risk for resistance and monotherapy is okay what drugs can be given
Cefepime, piperacillin-tazobactam, levofloxacin, imipenem or meropenem
What are the only drugs that will not need renal adjustment
Oxacillin, Nafcillin, Linezolid
What are drug interactions that fluroquinolones have with certain supplements
Antacids, iron, magnesium, aluminum, calcium
What is MRSA covering antibiotic that has drug interactions with tSSRIs, tricyclic antidpressants, trazodone, venlafaxin, and mirtazapine
Linezolid
T/F: Fluroquinolones have caution in kids and could cause QT prolongation and hypoglycemia
True
What side effects should be considered when picking the MRSA covering antibiotic linezolid
Myelosupprsion, serotonin syndrome, low platelets
