Nosocomial Pneumonia Flashcards
What is nosocomial pneumonia? What are the types of NAP?
-hospital acquired pneumonia (HAP)
Types:
- ventilator associated pneumonia (VAP)
- health care associated pneumonia (HCAP)
Hospital acquired pneumonia, Ventillator acquire pneumo, & Health care associated pneumonia definition?
- HAP: developes more than 48hrs after admission to hospital
- VAP: development of pneumonia in a mechanically ventilated patient 48 hrs after endotracheal intubation
- HCAP: development of pneumonia in an outpatient setting in an individual with extensive health care contact.
Risks of HCAP
- abx in last 3mo
- hospitalization in last 3mo of at least 2 day duration
- resident of a nursing home or extended care facility
- home infusion therapy within the last month
- long term dialysis
- home wound care
- family member with an infection involving a multiple drug resistant pathogen
- immunosuppression
Whats different in NAP than CAP?
NAP has:
- change in normal flora (develops different resistance patterns)
- different pathogens
- high frequency of drug resisitance
- pts have worse underlying health status
Pathophysiology of NAP
- colonization of the stomach and pharynx, these bugs get there because of placement of NG tubes.
- within 48hrs of admission 75% of seriously ill patients will have upper airway colonization with organisms from the hospital.
Most common NAP bugs
- staphlococcus aureus
- pseudomonas aeruginosa
- gram - rods
- -enterobacter
- klebsiella pneumoniae
- e. coli
Most common bugs causing VAP?
- MRSA
- P. aeruginosa
- MSSA
- Stenotrophomonas maltophilia
- acinetobacter
Signs and symptoms?
-same as community acquired pneumonia but more severe.
What are the diagnostic clues of each bug causing pneumonia?
-strep pneumo
- pseudomonas, haemophilus, pneumococcal
- Klebsiella
- anaerobic
strep: rust colored sputum
pseudo: green sputum
Klebsiella: red currant jelly sputum
Anaerobic: foul smelling or bad tasting sputum
Risk factors and features of Klebsiella pneumonia?
-RF: elderly, alcoholic, debilitated hospital pts
- Features: gram - member
- can cause extensive pulmonary necrosis
- cavitations seen on xray
- abscess formation
- (empyema)
- pleural adhesions(scar)
Sx of Klebsielle pneumonia?
-rapid onset of sever symptoms
- high fever and chills
- flulike sx
- cough productive of currant jelly like sputum
Klebsiella radiographic clues
- extensive lobar consolidation
- air bronchograms
- bulging fissure sign
- cavitary lesions (gas filled space in an area of consolidation)
Tx of Klebsiella pneumonia
- resistant to all of the big gun abx
- use impenem-cilastatin or meropenem
Legionella PNA sx
- gram stain?
- clinical findings
- GI sx (esp. diarrhea)**(ONLY pna to have diarrhea sx)
- neurologic findings (esp. confusion)
- fever >39C
Gram stain of respiratory secretions shows many neutrophils, but few, if any microorganisms.
- findings:
- hyponatremia
- hepatic dysfunction
- hematuria
- failure to respond to beta-lactam and/or aminoglycoside abx
Is legionella transmitted from person to person??
Treatment of legionella?
- nope, from contaminated water supply
- tx is macrolides of respiratory FQ
