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Infectious Disease > Nosocomial Pneumonia > Flashcards

Nosocomial Pneumonia Flashcards

1
Q

Types of nosocomial pneumonias

A
  • HAP (hospital-acquired pneumonia)
  • VAP (ventilatory assoc. pneumonia)
  • HCAP (Health care assoc. pneumonia)
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2
Q

HAP

A

develops more than 48 hours after admission to the hospital

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3
Q

VAP

A

Development of pneumonia in a mechanically ventilated pt 48 hours after enrtracheal intubation

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4
Q

HCAP

A

development of pneumonia in an outpt setting in an individual with extensive health care contact -> ex: dialysis

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5
Q

What is so scary about nosocomial pneumonia?

A

mortality: 20-50%

second most common cause of infection among hospitalized patients (behind UTIs)

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6
Q

Risk factors for HCAP

A
  • abx in last 3 months
  • hosp. in last 3 months of at least 2 days 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 (disease or therapy)
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7
Q

What makes nosocomial pneumonia different from CAP?

A
  • change in normal flora: flora develops different resistant patterns
  • different pathogens
  • High frequency of drug resistance
  • patients have worse underlying health status
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8
Q

pathophysiology of nosocomial pneumonia

A
  • colonization of the stomach and the pharynx : on NG tubes or ventilators
  • within 48 hours of admission 75% of seriously ill patients will have upper airway colonization with organisms from the hospital
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9
Q

Organisms associated with nosocomial pneumonia?

A
  • strep pneumo: often drug resistant
  • staph aureus: MSSA and MRSA
  • gram - rods: non-ESBL, ESBL: Klebsiella pneumonia, E. coli, Enterobacter
  • pseudomonas aeruginosa
  • Acinetobacter species
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10
Q

organisms associated with HAP?

A
  • staph aureus
  • Pseudomonas aeruginosa
  • gram - rods: enterobacter, Klebsiella pneumonia, E. coli
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11
Q

organisms associated with VAP?

A
  • MRSA 18%
  • P. aeruginosa 18%
  • MSSA 9%
  • stenotrophomonas maltophilia 7%
  • Acinetobactor sp 8%
  • other spp: 9%
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12
Q

HCAP associated organisms

A
  • all the common organisms that are more likely to be drug resistant
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13
Q

Signs and symptoms of nosocomial pneumonia

A
  • same as with community acquired pneumonia but more severe
  • appear acutely ill
  • fever
  • may have hypothermia (elderly)
  • tachypnea
  • tachycardia
  • decreasd SpO2
  • rales/crackles (inspiratory )
  • bronchial breath sounds
  • dullness to percussion
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14
Q

Diagnostic clues to nosocomial pneumonia?

A
  • strep pneumoniae: rust colored sputum
  • pseudomonas, Haemophilus and pneumococcal species: may produce green sputum
  • Klebsiella species pneumonia: red currant-jelly sputum
  • anaerobic infections: often produce foul-smelling or bad tasting sputum
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15
Q

RFs and features of Klebsiella pneumonia?

A

RFs: elderly, alcoholics, debilitated hospital pts

Features: gram - member of Enerobacteriacae, can cause extensive pulmonary necrosis, cavitations (holes) seen on X-ray, abscess formation (empyema), pleural adhesions

  • potentially fatal, up to 5% of pneumonia cases may be Klebsiella
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16
Q

Presentation of Klebsiella pneumonia

A
  • rapid onset of severe symptoms
  • high fever and chills
  • Flulike symptoms
  • cough productive of “Currant jelly” like sputum (bloody)
17
Q

Klebsiella radiographic clues

A
  • extensive lobar consolidation
  • air bronchograms
  • bulging fissure sign
  • cavitary lesions (gas filled space in an area of consolidation)
18
Q

Tx of Klebsiella pneumonia

A
  • usually extended spectrum b-lactamase positive so resistant to B-lactam and B-lactamase inhibitors, co-resistance to all FQs and often aminoglycosides
  • use: imipenem-cilastatin
    or meropenem
19
Q

legionella characteristics, and tx

A
  • GI sxs, especially diarrhea
  • neurologic findings, especially confusion
  • Fever > 39 C
  • gram stain of resp. secretions shows many neutrophils, but few, if any, microorganisms
  • hyponatremia
  • hepatic dysfunction
  • hematuria
  • failure to respond to b-lactam and/or amino glycoside abx
  • not transmitted from person to person
  • from contaminated water supply
  • macrolides or resp. FQ for tx
20
Q

staph aureus pneumonia

A
  • often seen post influenza
  • secondary bacterial infections typically establish during the second week of a viral infection. During viral clearing and recovery data suggest susceptibility is due to impaired innate immunity against bacterial infection following adaptive immune response to viral infection
  • MRSA assoc. with high mortality and necrotizing pneumonia
21
Q

Pseudomonas pneumonia

A
  • 2nd most common cause of nosocomial pneumonia
  • gram -
  • cough productive of purulent sputum, dyspnea, fever, chills, confusion, and severe systemic toxicity
  • characteristic sweet, grape-like odor
  • elaboration of green pigment
22
Q

RFs of pseudomonas pneumonia

A
  • Bronchiectasis (cystic fibrosis)
  • repeated abx use
  • prolonged oral glucocorticoid use in pts with structural lung disease (COPD, pulmonary fibrosis)
  • immunocompromised
  • previous hospitalizations
23
Q

General tx for nosocomial PNA

A

Imipenem or meropenem: if suspect Legionella add Levofloxacin or Moxifloxacin
if suspect MRSA -> + Vanco

if suspect pseudomonas:
Imipenem, or cefepime, or piperacillin tazobactam (Zosyn) + cipro or Tobramycin

24
Q

Prevention of nosocomial pneumonia?

A 
- avoid acid-blocking meds
(use sulfcralfate instead in hospitalized pts - coats gastric lining w/o altering pH)
- decontamination of oropharynx -> mouthwash
- pt positioning 
- subglottic drainage (Special ETT)
- preventing aspiration
- handwashing
- clean equipment
25
Q

Group A strep?

A

rare in US but especially deadly. GAS can cause a fulminant pneumonia with early empyema formation even in young, immunocompetent hosts
- acute and rapidly progressive respiratory failure and pulmonary hemorrhage

Infectious Disease (27 decks)

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