VAP Plus HCAP

Question 1

How long must a patient be on a ventilator to be considered VAP?

Answer 1

> 48 hours

Question 2

What are the 3 factors to pathogenesis of VAP

Answer 2

Colonization of the oropharynx
Aspiration of these organism
Compromise of the normal host defense

Question 3

When is an infection considered HAP

Answer 3

> 48hours of admission

Question 4

VAP risk factors

Answer 4

ETT, oropharynx flora replaced by pathogenic microorganisms, immunoparalysis, antibiotic selection pressure, cross infection, contaminated equipment, malnutrition

Question 5

Common organisms associated with VAP

Answer 5

MDR, pseudomonas, MRSA, atypicals

Question 6

Complications of VAP

Answer 6

Prolonged ventilation, necrotizing pneumonia (pulm hemorrhage, bronchiectasis, parenchymal scarring), catabolic state, permanent inability to return to independent living

Question 7

HCAP and VAP ABX treatment plan

Answer 7

No MDR risk factors: single agent (zosyn, cefepime, or levofloxacin)
MDR RISK: Cover for pseudomonas and MRSA (Zosyn, cefepime OR merrem, vanco) If severely ill consider aminoglycoside or flourquinolone

Question 8

Risk factors for MDRO

Answer 8

Prolonged hospitalization, recent antibiotic use, intubation, immunocompromised, ARDS