nosocomical pnuemonia

Question 1

what is nosocomial pneumonia?

Answer 1

Any infection that first appears 48 hours or more after hospital admission

Question 2

risk factors for nosocomical pneumoniia

Answer 2

age and co morbidity

↑ invasive diagnostic methods

↑ chemotherapy

Intensive Care Unit

ventilators / endotracheal tubes

Question 3

CAUSES

Answer 3

The primary route by which organisms enter the lower airways is aspiration of oropharyngeal secretions into the trachea
inhilation

Question 4

most common organisms

Answer 4

P. aeruginosa,
S. aureus and Enterobacteriaceae (especially Klebsiella, E. coli and Enterobacter spp.).

Early-onset HAP or VAP is often caused by typical antimicrobial-susceptible community organisms such as Streptococcus pneumoniae or Haemophilus influenzae.

Late-onset HAP or VAP is commonly caused by P. aeruginosa or other antimicrobial-resistant opportunistic Gram-negative bacteria or by MRSA

Question 5

the pathogenesis of VAP

Answer 5

3 factors are critical in the pathogenesis of VAP
• colonization of the oropharynx with pathogenic microorganisms
• aspiration of these microorganisms into lower resp. Tract
• compromise of the normal host defense mechanisms

the endotracheal tube (ET) reduces the danger of large aspirations but increases the microaspiration of secretions pooling above the ET, also it may damage the tracheal wall and further facilitates colonization.
The bacteria may form a glycocalyx biofilm in the ET that protects them from both antibiotics and hosts defenses

only 1/3 of colonized patients may develop VAP mostly severely ill patients with sepsis and trauma developVAP due to a state of immunoparalysis in the ICU

Question 6

how can you diagnose nosocomial pneumonia

Answer 6

chest radiograph
bronchupneumonia - patchy consolidation

CPIS

atypical pneumonia consolidation near hilar looking reticular

lobar pneumonia

sputum - gram staining

Microbiological sampling methods

Bronchoscopy-directed protected specimen brush (PSB) and

BAL

Question 7

what are the physical exam findings ?

Answer 7

dullness to precussion 
tactile vocal fremitus 
late insiratory crackles 
tachycardia 
fever 
tachypnea 
bronchial breath sounds

Question 8

Prevention of HAP?

Answer 8

selective decontamination of the digestive tract (SDD)

parenteral antibiotic prophylaxis

Question 9

treatment HAP?

Answer 9

Patients with early-onset infections (fewer than 5 days) who have not previously received antibiotics and in the absence of other risk factors of MDR, should be treated with monotherapy with ceftriaxon

Patients with early-onset infections who have recently received antibiotics and/or who have other risk factors or patients with late onset NP : third-generation cephalosporin (cefotaxime or ceftriaxone), a fluoroquinolone or piperacillin

Definitive treatment when the causative organism is P. Aeruginosa: Treatment options include ceftazidime, ciprofloxacin

Definitive treatment when the causative organism is MRSA: linezolid