Nosocomial Pneumonia

Question 1

Nosocomial pneumonia:

3 types?

Answer 1

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

Question 2

HAP definition?

VAP definition?

Answer 2

Develops more than 48 hours after admission to the hospital

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

Question 3

HCAP definition?

Answer 3

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

Question 4

Mortailty of nosocomial pneumonia?

Answer 4

20-50%

Question 5

Risk factors for HCAP?

8

Answer 5

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)

Question 6

What is different from CAP?

4

Answer 6

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

Question 7

Pathophysiology

of nosocomial: Where does the bacteria colonize and why?

Answer 7

Colonization of the stomach and pharynx

Nasogastric tube

Question 8

Organisms that cause nasocomial pneumonia?

5

Answer 8

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

Question 9

Bugs mostly causing HAP?

5

Answer 9

Staphlococcus aureus
Pseudomonas aeruginosa

Gram negative rods

• Enterobacter
• Klebsiella pneumoniae
• Escherichia coli

Question 10

Bugs mostly causing VAP?
5
Whats the most common?

Answer 10

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

Question 11

HCAP Common organisms that are more likely to be?

Answer 11

drug resistant

Question 12

Signs and symptoms

of noscomial pneumonia?

Answer 12

Same as with community acquired pneumonia but more severe

Question 13

Diagnostic clues

for Streptococcus pneumoniae?

Answer 13

Rust-colored sputum

Question 14

Diagnostic clues Pseudomonas, Haemophilus, and pneumococcal species?

Answer 14

May produce green sputum

Question 15

Diagnostic clues for Klebsiella species pneumonia?

Answer 15

Red currant-jelly sputum

Question 16

Diagnostic clues for Anaerobic infections:

Answer 16

Often produce foul-smelling or bad-tasting sputum

Question 17

Klebsiella pneumonia
risk factors?
3

Answer 17

Elderly
Alcoholics
Debilitated hospital pts

Question 18

Klebsiella pneumonia
features:

What group of bacteria is it part of?

What can it cause?

What is seen on the XRAy?
3

Answer 18

Gram negative member of Enerobacteriacae

Can cause extensive pulmonary necrosis

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

Question 19

Klebsiella pneumonia
clinical manifestations:

Onset?
Symtpoms?
Cough?

Answer 19

Rapid onset of severe symptoms

Flulike symtpoms (fever and chills)

Productive of current jelly

Question 20

Klebsiella radiographic clues?

4

Answer 20

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

Question 21

Treatment of Klebsiella pneumonia?

2

Answer 21

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

Question 22

Legionella characteristics

Answer 22

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

Question 23

How is legionella spread?

Treatment?2

Answer 23

Not transmitted from person to person
From contaminated water supply

Macrolides or Respiratory FQ for treatment

Question 24

Staphlococcus aureus pneumonia is often seen when?

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

Answer 24

Often seen post influenza

MRSA

Can be dangerous even in young immunocomprimised questions

Question 25

Pseudomonas aeruginosa pneumonia has what kind of symtpoms? 5 What is the characteristic odor? Pigment?

Answer 25

1. Cough productive of purulent sputum, 2. dyspnea, 3. fever, chills, 4. confusion, and 5. severe systemic toxicity Characteristic sweet, grape-like odor Green

Question 26

Risk factors for pseudomonas? 5

Answer 26

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

Question 27

General Treatment for Nosocomial PNA?? 2 If you suspect Legionella add on what? 2 If you suspect MRSA? If you suspect pseudomonas? 4

Answer 27

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

Question 28

Prevention of nosocomial pneumonia? | 7

Answer 28

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

Question 29

Why are acid blocking meds a risk factor for pneumonia?

Answer 29

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