Explanation of a microbiological algorithm for Hospital-acquired and Ventilator associated pneumonia.
This algorithm is intended to deal with the microbiological aspects of hospital-acquired and ventilator-associated pneumonia.
The severity of the illness is important in determining when to collect the diagnostic samples and which antimicrobials to administer due to which organisms are present. There are many prognostic scoring systems used to suggest the severity of the disease in patients e.g., The Therapeutic Intervention Scoring System and the Mortality Predictor Model. (Napolitano, 2010)
For this algorithm the guidelines used were produced by the American Thoracic Society and Infectious Diseases Society of America which classify the …show more content…
For example the mild/moderate pneumonia, with no risk factors for resistant organisms, is on the left side of the algorithm and the treatment for these patients may be different to more severe cases. Even in a mild/moderate presentation, the presence of potentially resistant pathogens, such as MRSA, is a risk factor that requires more potent treatment. (Rotstein, 2008) Therefore secondary tests such as Cefoxitin disk screen test and the use of ELISA testing should be used to distinguish between MSSA and MRSA, for example. These were therefore placed in the secondary testing row of the …show more content…
This is a common way to collect LRT secretions as it is a non-invasive method; however it is not an effective way of distinguishing colonization in the upper airways from the lower airways. (Carroll, 2002) So the results obtained must be carefully interpreted to determine if the pathogen has colonized in the URT or represents a disease in the LRT. (Hammitt et al, 2012) Therefore, bronchoalveolar lavage fluid is used, which is an invasive procedure but can obtain pathogens that have colonised more specifically in the LRT.
Sputum and BAL samples can be used to identify other less common pathogens that can be responsible for HAP/VAP, such as the Acinetobacter species. This pathogen is responsible for a relatively small percentage of cases of HAP and VAP but when an infection of a member of the Acinetobacter spp. occurs it can present major problems mainly due to the increase of multidrug resistance in clinical environments. (Hartzell et al, 2007) An infection of this species can be confirmed using PCR as a secondary
This algorithm is intended to deal with the microbiological aspects of hospital-acquired and ventilator-associated pneumonia.
The severity of the illness is important in determining when to collect the diagnostic samples and which antimicrobials to administer due to which organisms are present. There are many prognostic scoring systems used to suggest the severity of the disease in patients e.g., The Therapeutic Intervention Scoring System and the Mortality Predictor Model. (Napolitano, 2010)
For this algorithm the guidelines used were produced by the American Thoracic Society and Infectious Diseases Society of America which classify the …show more content…
For example the mild/moderate pneumonia, with no risk factors for resistant organisms, is on the left side of the algorithm and the treatment for these patients may be different to more severe cases. Even in a mild/moderate presentation, the presence of potentially resistant pathogens, such as MRSA, is a risk factor that requires more potent treatment. (Rotstein, 2008) Therefore secondary tests such as Cefoxitin disk screen test and the use of ELISA testing should be used to distinguish between MSSA and MRSA, for example. These were therefore placed in the secondary testing row of the …show more content…
This is a common way to collect LRT secretions as it is a non-invasive method; however it is not an effective way of distinguishing colonization in the upper airways from the lower airways. (Carroll, 2002) So the results obtained must be carefully interpreted to determine if the pathogen has colonized in the URT or represents a disease in the LRT. (Hammitt et al, 2012) Therefore, bronchoalveolar lavage fluid is used, which is an invasive procedure but can obtain pathogens that have colonised more specifically in the LRT.
Sputum and BAL samples can be used to identify other less common pathogens that can be responsible for HAP/VAP, such as the Acinetobacter species. This pathogen is responsible for a relatively small percentage of cases of HAP and VAP but when an infection of a member of the Acinetobacter spp. occurs it can present major problems mainly due to the increase of multidrug resistance in clinical environments. (Hartzell et al, 2007) An infection of this species can be confirmed using PCR as a secondary