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Infectious Disease > Nosocomial Pneumonia > Flashcards

Nosocomial Pneumonia Flashcards

1
Q

Nosocomial pneumonia:

3 types?

A

Hospital-acquired pneumonia (HAP)
Ventilator associated pneumonia (VAP)
Health care associated pneumonia (HCAP)

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2
Q

HAP definition?

VAP definition?

A

Develops more than 48 hours after admission to the hospital

Development of pneumonia in a mechanically ventilated patient 48 hours after endotracheal intubation

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3
Q

HCAP definition?

A

Development of pneumonia in an outpatient setting in an individual with extensive health care contact

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4
Q

Mortailty of nosocomial pneumonia?

A

20-50%

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5
Q

Risk factors for HCAP?

8

A
  1. Antibiotics in the last 3 months
  2. Hospitalization in the last 3 months of at least 2 days duration
  3. Resident of a nursing home or extended care facility
  4. Home infusion therapy within the last month
  5. Long term dialysis
  6. Home wound care
  7. Family member with an infection involving a multiple drug resistant pathogen
  8. Immunosuppression (disease or therapy)
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6
Q

What is different from CAP?

4

A
  1. Change in normal flora
    - -Flora develops different resistance patterns
  2. Different pathogens
  3. High frequency of drug resistance
  4. Patient’s have worse underlying health status
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7
Q

Pathophysiology

of nosocomial: Where does the bacteria colonize and why?

A

Colonization of the stomach and pharynx

Nasogastric tube

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8
Q

Organisms that cause nasocomial pneumonia?

5

A
  1. Streptococcus pneumonia
    - -Often drug resistant
  2. Staphlococcus aureus
    - -MSSA and MRSA
  3. Gram negative rods
    - -Non-ESBL
    - -ESBL : Klebsiella pneumonia, Escherichia coli and Enterobacter
  4. Pseudomonas aeruginosa
  5. Acinetobacter species
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9
Q

Bugs mostly causing HAP?

5

A

Staphlococcus aureus
Pseudomonas aeruginosa

Gram negative rods

  • Enterobacter
  • Klebsiella pneumoniae
  • Escherichia coli
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10
Q

Bugs mostly causing VAP?
5
Whats the most common?

A 
MRSA 18%
P. aeruginosa 18%
MSSA 9%
Stenotrophomonas maltophilia 7%
Acinetobacter spp 8%
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11
Q

HCAP Common organisms that are more likely to be?

A

drug resistant

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12
Q

Signs and symptoms

of noscomial pneumonia?

A

Same as with community acquired pneumonia but more severe

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13
Q

Diagnostic clues

for Streptococcus pneumoniae?

A

Rust-colored sputum

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14
Q

Diagnostic clues Pseudomonas, Haemophilus, and pneumococcal species?

A

May produce green sputum

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15
Q

Diagnostic clues for Klebsiella species pneumonia?

A

Red currant-jelly sputum

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16
Q

Diagnostic clues for Anaerobic infections:

A

Often produce foul-smelling or bad-tasting sputum

17
Q

Klebsiella pneumonia
risk factors?
3

A

Elderly
Alcoholics
Debilitated hospital pts

18
Q

Klebsiella pneumonia
features:

What group of bacteria is it part of?

What can it cause?

What is seen on the XRAy?
3

A

Gram negative member of Enerobacteriacae

Can cause extensive pulmonary necrosis

  1. Cavitations seen on xray
  2. Abscess formation (empyema)
  3. Pleural adhesions
19
Q

Klebsiella pneumonia
clinical manifestations:

Onset?
Symtpoms?
Cough?

A

Rapid onset of severe symptoms

Flulike symtpoms (fever and chills)

Productive of current jelly

20
Q

Klebsiella radiographic clues?

4

A
  1. Extensive lobar consolidation
  2. Air bronchograms
  3. Bulging fissure sign
  4. Cavitary lesions (gas filled space in an area of consolidation)
21
Q

Treatment of Klebsiella pneumonia?

2

A

Usually extended spectrum beta-lactamase positive so resistant to B-lactam and B-lactamase inhibitors, co-resistance to all FQs and often aminoglycosides

SOOOOOO

Imipenem-cilastatin
Meropenem

22
Q

Legionella characteristics

A
  1. GI symptoms, especially diarrhea
  2. Neurologic findings, especially confusion
  3. Fever >39ºC
  4. Gram stain of respiratory secretions shows many neutrophils, but few, if any, microorganisms
  5. Hyponatremia
  6. Hepatic dysfunction
  7. Hematuria
  8. Failure to respond to beta-lactam and/or aminoglycoside antibiotics
23
Q

How is legionella spread?

Treatment?2

A

Not transmitted from person to person
From contaminated water supply

Macrolides or Respiratory FQ for treatment

24
Q

Staphlococcus aureus pneumonia is often seen when?

What infection is seen associated with high mortality and necrotizing pneumonia?

A

Often seen post influenza

MRSA

Can be dangerous even in young immunocomprimised questions

25
Q

Pseudomonas aeruginosa pneumonia has what kind of symtpoms?
5

What is the characteristic odor?
Pigment?

A
  1. Cough productive of purulent sputum,
  2. dyspnea,
  3. fever, chills,
  4. confusion, and
  5. severe systemic toxicity

Characteristic sweet, grape-like odor
Green

26
Q

Risk factors
for pseudomonas?
5

A
  1. Bronchiectasis (cystic fibrosis)
  2. Repeated antibiotic use
  3. Prolonged oral glucocorticoid use in patient’s with structural lung disease (COPD, pulmonary fibrosis)
  4. Immunocompromised
  5. Previous hospitalizations
27
Q

General Treatment for Nosocomial PNA??
2

If you suspect Legionella add on what? 2

If you suspect MRSA?

If you suspect pseudomonas?
4

A

Imipenem or meropenem

Levofloxacin (Levaquin) or Moxifloxacin (Avelox)

Vanco

  1. Imipenem (Primaxin, Tienam) or
  2. cefepime (Maxipime) or
  3. piperacillin-tazobactam (Zosyn) + Cipro
  4. Tobramycin
    ADD AN FQ, cipro
28
Q

Prevention of nosocomial pneumonia?

7

A
  1. Avoid acid-blocking medications
    - -Use sulcralfate instead in hospitalized patients
  2. Decontamination of the oropharynx
  3. Patient positioning
  4. Subglottic drainage (special ETT)
  5. Preventing aspiration
  6. Handwashing
  7. Clean equipment
29
Q

Why are acid blocking meds a risk factor for pneumonia?

A

gets rid of all the acid in the stomach that fights that pathogenic bacteria

Infectious Disease (29 decks)

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