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PR3124 CA3 > HAP/VAP (nosocomial) > Flashcards

HAP/VAP (nosocomial) Flashcards

1
Q

what are the risk factors of HAP/VAP?

A 
patient related factors
- elderly
- smoking
- COPD
- cancer, immunosup
- prolonged hospitalisation
- coma, impaired consciousness
- malnutrition
infection control related factors
- hand hygiene compliance
- contaminated resp care device
healthcare related factors
- prior ab use
- sedative
- opioid analgesics
- mech ventilation
- supine position (easier to choke on secretion when lying down)
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2
Q

what are some prevention strategies for HAP/VAP?

A
  • practice consistent hand hygiene

- judicious use of ab and med with sedative effect

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3
Q

what are some prevention strategies for VAP specifically?

A
  • limit duration of mech ventilation
  • minimise duration and deep level of sedation
  • elevate head of bed by 30 deg (min risk of aspirating oro-pharyngeal secretion)
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4
Q

what org to cover for HAP/VAP?

A 
gram pos
- strep pneumo
- s aureus
gram neg
- h flu
- prteus spp
- e coli
- enterobacter spp
- klebsiella pneumo (MRSA)
- ps aeruginosa (MRSA)

more gram neg, esp MRSA gram nef

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5
Q

what is the empiric coverage?

A

MINIMUM
- cover S aureus MSSA and Ps aeruginosa MRSA
may need additional cove for
- MDRO risk factors
- mortality risk factors
- hospital or unit bacteria susceptibiity rate (use antibiogram)

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6
Q

what are the MDRO risk factors for HAP? (1)

A
  • prior IV ab within 90 days
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7
Q

what are the MDRO risk factors for VAP? (5)

A
  • prior iv ab within 90 days
  • septic shock (hypotension caused by infection, req vasoactive med) at the time of VAP onset
  • acute resp distress syndrome preceding VAP onset
  • > 5 days of hospitalisation prior to VAP onset
  • acute renal replacement therapy prior to VAP1
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8
Q

wat are teh mortality risk factors for HAP? (2)

A
  • req mech ventilation as a result of HAP

- in septic shock

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9
Q

what ab covers both MSSA and pseudomonas? (4)

A
  • cefepime
  • meropenem
  • pip/tazo
  • levofloxacin
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10
Q

what is the purpose of an antibiogram

A

to guide empiric therapy selection

tells you how resistant the org is in the hospital

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11
Q

what is the backbone regimen for HAP? empiric tx

A
  • anti-pseudomonal beta lactam (piptazo or cefepime or meropenem or imipenem)
    OR
  • antipseudomonal FQ (levofloxacin)
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12
Q

what org to cover for backbone regimen?

A
  • strep pneumo
  • s aureus mssa
  • pseudonomas aeruginosa
  • ab sensitive enterobacteraceae eg. e coli, proteus spp, enterobacterspp.
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13
Q

who needs empiric MRSA coverage?

A
  • MDRO risk factors
  • mortality risk fac
  • MRSA prevalance >20% or unknown
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14
Q

if indicated, what ab to add to backbone regimen for MRSA cov for HAP?

A
  • vancomycin
  • linezolid
    (NOT daptomycin even tho it covers for MRSA coz it get sinactivated in the lungs)
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15
Q

who needs additional gram neg cov in HAP?

A
  • MDRO risk fac

- mortality risk fac

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16
Q

if indicated, what ab to add to backbone regimen for additional gram neg cov for HAP?

A
  • gentamicin
  • amikacin
  • tobramycin
  • ciproflaox
  • levoflox
    • choose 2 drugs from diff class- coz there could be cross resistance from drugs in same class
17
Q

what is the backbone empiric tx for VAP?

A
  • anti pseudomonal beta lactam (piptazo or cefepime or meropenem or imipenem)
    OR
  • antipseudomonal FQ (levofloxacin)
18
Q

who needs empiric MRSA coverage for VAP?

A
  • MDRO risk factors

- MRSA prevalence >10-20% or unknown

19
Q

if indicated, what ab to add to backbone regimen for MRSA cov for VAP?

A
  • vancomycin

- linezolid

20
Q

who needs additional gram neg cov in VAP?

A
  • MDRO risk fac

- single anti pseudomonal agent with activity <90% or unknown

21
Q

if indicated, what ab to add to backbone regimen for additional gram neg cov for VAP?

A
  • gentamicin
  • amikacin
  • tobramycin
  • levoflox
    ciprioflox
22
Q

what are teh benefits of additional gram neg cov (give 2 drugs that cover gram neg)?

A
  • synergistic actiity
  • prevent resistance
  • expand spectrum of cov
23
Q

what are the potential risks of additional gram neg cov

A
  • higher cost

- more adverse effects

24
Q

so why is additional gram neg cov still rec empirically?

A

to broaden spectrum of gram neg coverage in pt who are at risk for MDRO or death
prevent death

25
Q

when to de-escalate?

A
  • positive culture with documented susceptibility
    OR neg blood and resp cultures
    AND
    clinically imrpoving
26
Q

How to de-escalate?

A

positive blood and or resp culture
- maintain cov for org grown
neg blood or resp culture
- maintain cov for gram neg bacilli and MSSA (complete therapy for ab covering gram neg and mSSA)

27
Q

how to monitor for efficacy of tx?

A

clniical improvement expected in 72h

  • less cough, chest pain, SOB, fever, WBC, tachypnea, o2 req
  • elderly or those with multiple comorb may take longer
28
Q

what is the rec tx duration?

A

7 days, regardless of pathogen

** no burkholderia- coz pt in hospital, should not be exposed to contaminated soil or water

PR3124 CA3 (6 decks)

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