Hospital Acquired pneumonia

Question 1

What is hospital-acquired pneumonia

Answer 1

an acute infection of the pulmonary parnenchyma with development of the pneumonia at least 48 hours after hospitalization

Question 2

What is ventilator-acquired pneumonia

Answer 2

pneumonia that develops after 48 hours of a patient being intubated

Question 3

What diseases can impair lung defenses

Answer 3

Guillian Barre, Multiple Sclerosis, Seizures, Cystic Fibrosis, Myocardial Infaction, Stroke, HIV

Question 4

What are factors that can lead to a patient acquiring hospital acquired pneumonia

Answer 4

Medication Altering gastric emptying and pH, invasive devices with biofilm, prior antibioitics, host factors (immunosuppression, burns)

Question 5

T/F: Gram negative bacteria are the most likely to cause hospital-acquired pneumonia

Answer 5

True

Question 6

What are negative bacteria that cause hospital-acquired pneumonia

Answer 6

Pseudomonas aeruginosa, enterobacter sp., klebsiella pneumoniae, escherichia coli, hemophilus influenzae, acinetobacter, stenotrophamonas maltophilia

Question 7

What are gram positive bacteria that cause hospital-acquired pneumonia

Answer 7

Staphylococcus aureus, streptococcus pneumniae

Question 8

What are general risk factors for acquring hospital acquired pneumonia

Answer 8

Mechanical ventillation, length of hospitalization, prior antibiotic use, age greater than 70, H2 blocker use, bactermia

Question 9

What are the risk factors for multi-drug resistant pathogens

Answer 9

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

Question 10

What should be done if the patient has risk factors for multi-drug resistant pathogens

Answer 10

Give 2-3 drugs

Question 11

What are new signs and symptoms that could lead to a diagnosis of HAP/VAP

Answer 11

Fever, increased WBC, increased sputum production

Question 12

When should MRSA be covered for in HAP/VAP

Answer 12

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

Question 13

What are the antibiotic choices for covering MRSA

Answer 13

Vancomycin 15-20 mcg/ml OR Linezolid 600 mg IVPB every 12 hours

Question 14

If there are no MRSA risk factors what antibiotics can be used emperically used

Answer 14

Piperacillin-tazobactam, cefepime, levofloxacin, imipenem or meropenem

Question 15

If MSSA is isolated what antibiotics should be used

Answer 15

Nafacillin 2 grams IVPB every 4 hours OR oxacillin 2 gram IVPB every 4 hours OR Cefazolin 2 grams every 8 hours

Question 16

When should 2 drugs for pseudomonas or resistant gram negative organisms be used

Answer 16

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

Question 17

What are the first group of antibiotics that can be used when trying to cover for pseudomonas or resistant gram negative organisms

Answer 17

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

Question 18

What is the second group of antibiotics that can be used when trying to cover for pseudomonas or resistant gram negative organisms

Answer 18

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

Question 19

If there is no risk for resistance and monotherapy is okay what drugs can be given

Answer 19

Cefepime, piperacillin-tazobactam, levofloxacin, imipenem or meropenem

Question 20

What are the only drugs that will not need renal adjustment

Answer 20

Oxacillin, Nafcillin, Linezolid

Question 21

What are drug interactions that fluroquinolones have with certain supplements

Answer 21

Antacids, iron, magnesium, aluminum, calcium

Question 22

What is MRSA covering antibiotic that has drug interactions with tSSRIs, tricyclic antidpressants, trazodone, venlafaxin, and mirtazapine

Answer 22

Linezolid

Question 23

T/F: Fluroquinolones have caution in kids and could cause QT prolongation and hypoglycemia

Answer 23

True

Question 24

What side effects should be considered when picking the MRSA covering antibiotic linezolid

Answer 24

Myelosupprsion, serotonin syndrome, low platelets

Question 25

What antibiotics used to treat isolated MSSA have a side effect of rash

Answer 25

Oxacillin and Naficillin

Question 26

What are antibiotics that cause rash, diarrhea, and seizures

Answer 26

Carbapenems

Question 27

T/F:Cephaloprorins also rash, diarrhea and seizures

Answer 27

False: Cephalosporins only cause rash and diarrhea

Question 28

What possible monotherapy should be avoided if the patient has low platelets

Answer 28

piperacillin-tazobactam

Question 29

What classes of antibioitics, that are used to cover for pseudomonas or resistant gram negatives, cause nephrotoxicity

Answer 29

Aminoglcosides, colistin, polymxin B

Question 30

What MRSA covering drug causes nephrotoxicity, otoxicity, and infusion reactions

Answer 30

Vancomycin

Question 31

T/F: Aztreonam can cause neutropenia and increased liver enzymes

Answer 31

True

Question 32

If there is an increased risk for anaerobes what antibiotics can be added to the regiment, when would these drugs not be added

Answer 32

Metronidazole or clindamycin/ imipenem, meropenem and piperacillin/tazobactam

Question 33

What antibiotic should be given if a fungus is isolated or suspected

Answer 33

Liposomalamphotericin B 100-150 mg daily

Question 34

If an extended spectrum beta lactamase producing organism what antibiotics should be used, what can be added on

Answer 34

Carbapenem, beta-lactamse inhibitor/ Fluroquinolone and/or aminoglycoside

Question 35

T/F: If a patient has carbapenem resistance use colistin, polymixin B and/or aztreonam

Answer 35

True

Question 36

When organisms are sensitive only to aminoglycosides or colisitn what should be considered

Answer 36

Administering these antibiotics via inhalation

Question 37

What is the length of therapy for all

Answer 37

7 days