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37 Cards in this Set
- Front
- Back
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HAP
early onset |
<4 days
better prognosis less resistence |
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HAP
late onset |
>5 days of hospitalization
more MDR increase mortality |
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whats the attributable mortality to HAP
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30-50%
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what are the aerobic gram neg species in HAP
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Psuedomonas aeuginosa
E. coli Acinetobacter species Kleb |
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whats most common HAP species
whats it mech of resistence |
psudeomonas
efflux pumps |
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whats best way to tx kleb
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carbapenem
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pathogenesis of HAP
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infections occur when colonization overcomes hosts
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whats a way to help dec risk in VAP
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use chlorhexadine
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daignosis of HAP
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new lung infiltrate
+ 2 of 3 (Temp, WBC, secretions, dec o2 sat) |
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risk factors for HCAP
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hosp for >2days in last 90days
living in nursing facility dialysis wound care home infusion |
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HAP limited spectrum
recommended ABX |
ceftriaxone
or levoflox, moxiflox, cipro or unasyn or ertapenem |
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common pathogens in HAP limited spectrum
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step pneumo
H. Flu MRSA ABX gram - Rods -proteus, Ecoli, kleb, serratia |
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HAP broad spectrum
recommended ABX tx |
antipsuedomonal ceph
or antipseudomonal carbapen or antipsuemonal blactam/lactam inhib + AP FQ or AG |
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common broad spectrum MDR pathogens
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PEAK
MRSA legionella |
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if legionella choose which regimen
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one with macrolide or FQ
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cefepime
dose for MDR HAP |
1-2 g q 8-12H
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Ceftazidime
dose for MDR HAP |
2 g q 8H
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imipenem
dose for MDR HAP |
500mg q 6H
or 1G Q 8H |
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meropenem
dose for MDR HAP |
1g Q 8H
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Zosyn
dose for MDR HAP |
4.5g q 6H
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gentamicin
tobramycin dose for MDR HAP |
7mg/kg/day
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amikacin
dose for MDR HAP |
20mg/kg/day
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levofloxacin
dose for MDR HAP |
750mg q D
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ciprofloxacin
dose for MDR HAP |
400mg Q 8H
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Vanco
dose for MDR HAP |
15mg/kg Q 12h
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Linezolid
dose for MDR HAP |
600mg Q 12H
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when to stop AG
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if responding to combo meds, stop AG after 5-7days
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general HAP prophylaxis
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alcohol hand santizer
staff education |
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which tubes are preferred
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orotracheal
orogastric reduce risk of VAP |
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what can reduce length of stay
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adequate staffing in ICU
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whats best position for pt
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30-45degrees
prevents aspiration |
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which nutrition is preferred
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enteral not parenteral
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whats goal of BG in HAP
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80-110
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what may reduce VAP but increase bleeds
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sucralfate
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steps in treating HAP,VAP
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sample for culture
begin empiric tx (don't if low susp. + neg micro) day 2-3: check cultures + Temp, WBC, chest xrays, o2 |
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if clinical impt at 48-72s do what
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check cultures
if negative- stop ABX if positive- treat for 7-8days |
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whats typical tx duration for HAP
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14-21 days
try to shorten to 7-8 days if approp tx,except if psuedomonas |
