Nosocomial Pneumonia

Front 1

What is Healthcare Associated Pneumonia?

Back 1

1. In an acute care hospital for two or more days w/in 90 days of the infection.
2. I.V. antibiotic therapy, chemotherapy, wound care within 30 days.
3. attended a hospital or hemodialysis clinic.

Front 2

How do patients get VAP

Back 2

1. Bacterial entry to respiratory tract:
a. aspiration, leakage of secretions
2. Host and Tx related colonization.
3. Biofilm
4. Sources of Pathogens:
- healthcare devices, staff, enviroment.

Front 3

What are some of the bacteria that can come from health care personnal:

Back 3

- Staphylococci
- gram-negative bacteria (pseudomonas and acinetobacter spp)

Front 4

Ventilator devices:

Back 4

- staphylococci, enterobacteriae, legionella.

Front 5

Faecal oral

Back 5

enterobacteriaceae

Front 6

What are some of the NON-MODIFYABLE risk factors for HAP?

Back 6

- SEX
- underlying disease (COPD)

Front 7

What are some of the modifyable risk factors?

Back 7

- Body positioning
- Intubation/Mechanical Ventilation
- Concomitant use of antacids
- Enternal feedings
- Transfusion
- Hyperglycemia.

Front 8

What is the onset of VAP/HAP?

Back 8

Early-onset of VAP/HAP:
- first 4 days
- better prognosis
- usually antibiotic sensitive bacteria.

Front 9

What is the late - onset of VAP/HAP?

Back 9

- 5 days or more
- multi-drug resistnace pathogens
- increase morbidity or mortality.

Front 10

What are some of the organisms that are related to HAP/VAP?

Back 10

Gram Negative:
Serratia spp.
Pseudomonas spp.
Acinetobacter spp.
Citrobacter spp.
Enterobacter spp.
Gram (+): staph, strept, oropharyngeal (streptococcus viridans, coag (-) staphylococcus, corynebacterium)

Front 11

Random pathogens that cause HAP/VAP

Back 11

- Klebsiella
- H. influenza
- Stenotrophomonas
- Legionella
- Virus
- Fungus

Front 12

Early onset of Nosocomial Pneumonia

Back 12

S. pneumoniae
H. Influenza
S. aureus
Viruses

Front 13

Late onset of nosocomial pneumonia.

Back 13

Psuedomonas aeruginosa
MRSA and methicillin-sensitive
Aerobic gram - bacteria --> acinebacteriacae
- enterobacteriacae

Front 14

Immunocompromised patients:

Back 14

- stenotrophomonas
- fungus, viruses

Front 15

What drugs have become resistant to psuedomonas, acinebacter, enterobacter, klebsiella?

Back 15

1. Cephalosporins
2. Carbapenems
3. Fluoro
4. Amino
5. Piperacillin/Tazobactam

Front 16

Risk factors for MDR pathogens:

Back 16

1. Antimicrobial therapy in preceding 90 days.
2. Current hospitalization >= 5 days.
3. High freq. of antibiotic resistance in the community or specific hospital unit.
4. Presence of risk factors for HCAP
5. Immunosuppressive disease and/or therapy.

Front 17

Diagnosis of VAP/HAP:

MUST HAVE: infiltrate + 1 or more of

Back 17

1. New or progressive radiographic infiltrate.
2. Clinical findings of infection: new fever, purulent sputum, leukocytosis, decline in oxygenation.
3. w/o infiltrate on CXR = Tracheobronchitis.

Front 18

What are some of the cultures that should be taken for VAP/HAP?

Back 18

- Tracheal aspirate
- sputum: suctioned, bronchoalveolar lavage, protected brush specimen.
- blood cultures.

Front 19

If an early onset of HAP, how do you treat it?

Back 19

Zosyn or Rocephin + cleocin
Reaction to ceph or PCN:
GIVE CIPRO/LEVO + cleocin
MRSA: replace clin w/ vanco
Azithromycin or levo for atypicals.

Front 20

What should be adjust renal dose for?

Back 20

Cefepime
Ceftazidime
Imipenem
Meropenem
Zosyn
amino
Levo

Front 21

Early onset of Nosocomial Pneumonia

Back 21

S. pneumoniae
H. Influenza
S. aureus
Viruses

Front 22

Late onset of nosocomial pneumonia.

Back 22

Psuedomonas aeruginosa
MRSA and methicillin-sensitive
Aerobic gram - bacteria --> acinebacteriacae
- enterobacteriacae

Front 23

Immunocompromised patients:

Back 23

- stenotrophomonas
- fungus, viruses

Front 24

What drugs have become resistant to psuedomonas, acinebacter, enterobacter, klebsiella?

Back 24

1. Cephalosporins
2. Carbapenems
3. Fluoro
4. Amino
5. Piperacillin/Tazobactam

Front 25

Risk factors for MDR pathogens:

Back 25

1. Antimicrobial therapy in preceding 90 days.
2. Current hospitalization >= 5 days.
3. High freq. of antibiotic resistance in the community or specific hospital unit.
4. Presence of risk factors for HCAP
5. Immunosuppressive disease and/or therapy.

Front 26

Diagnosis of VAP/HAP:

MUST HAVE: infiltrate + 1 or more of

Back 26

1. New or progressive radiographic infiltrate.
2. Clinical findings of infection: new fever, purulent sputum, leukocytosis, decline in oxygenation.
3. w/o infiltrate on CXR = Tracheobronchitis.

Front 27

What are some of the cultures that should be taken for VAP/HAP?

Back 27

- Tracheal aspirate
- sputum: suctioned, bronchoalveolar lavage, protected brush specimen.
- blood cultures.

Front 28

If an early onset of HAP, how do you treat it?

Back 28

Zosyn or Rocephin + cleocin
Reaction to ceph or PCN:
GIVE CIPRO/LEVO + cleocin
MRSA: replace clin w/ vanco
Azithromycin or levo for atypicals.

Front 29

What should be adjust renal dose for?

Back 29

Cefepime
Ceftazidime
Imipenem
Meropenem
Zosyn
amino
Levo

Front 30

Vancomycin

Back 30

- TIME - DEPENDENT
- > 30 - 40 mcg/ml serum toxicity

Front 31

Reasons for deterioration or nonresolution

Back 31

1. No Pneumonia
2. Etiology not bacteria
3. Complicated pneumonia (absess
4. Resistant pathogen
5. Breakthrough infection
(too low dose)

Front 32

How long should a patient be on antibiotics for AHP?

Back 32

HAP: Antibiotic tx for 7 days., if fever persists up to 14 days.
psuedomonas: 14 days of antibiotic therapy.

Front 33

Descalation Therapy:

Back 33

narrow therapy to specific pathogen

Front 34

Broad spectrum (

Back 34

Cephalsporins (Cefepime, ceftazidime)
Carbepemems(Imipenem, Meropenem)
Betalactam/ase inhibitor:
piperacillin/tazobactam

PLUS: cipro/levo
or aminoglycoside (gentamicin, tobramycin, amikacin)

MRSA: VANCO, LINEZOLID
FLUOROQUINOLONE, AZITHRO --> FOR LEGIONELLA.