Flashcards in Nosocomial Pneumonia Deck (20):
What is nosocomial pneumonia? What are the types of NAP?
-hospital acquired pneumonia (HAP)
-ventilator associated pneumonia (VAP)
-health care associated pneumonia (HCAP)
Hospital acquired pneumonia, Ventillator acquire pneumo, & Health care associated pneumonia definition?
-HAP: developes more than 48hrs after admission to hospital
-VAP: development of pneumonia in a mechanically ventilated patient 48 hrs after endotracheal intubation
-HCAP: development of pneumonia in an outpatient setting in an individual with extensive health care contact.
Risks of HCAP
-abx in last 3mo
-hospitalization in last 3mo of at least 2 day duration
-resident of a nursing home or extended care facility
-home infusion therapy within the last month
-long term dialysis
-home wound care
-family member with an infection involving a multiple drug resistant pathogen
Whats different in NAP than CAP?
-change in normal flora (develops different resistance patterns)
-high frequency of drug resisitance
-pts have worse underlying health status
Pathophysiology of NAP
-colonization of the stomach and pharynx, these bugs get there because of placement of NG tubes.
*within 48hrs of admission 75% of seriously ill patients will have upper airway colonization with organisms from the hospital.
Most common NAP bugs
-gram - rods
Most common bugs causing VAP?
Signs and symptoms?
-same as community acquired pneumonia but more severe.
What are the diagnostic clues of each bug causing pneumonia?
-pseudomonas, haemophilus, pneumococcal
strep: rust colored sputum
pseudo: green sputum
Klebsiella: red currant jelly sputum
Anaerobic: foul smelling or bad tasting sputum
Risk factors and features of Klebsiella pneumonia?
-RF: elderly, alcoholic, debilitated hospital pts
-Features: gram - member
-can cause extensive pulmonary necrosis
-cavitations seen on xray
Sx of Klebsielle pneumonia?
-rapid onset of sever symptoms
-high fever and chills
-cough productive of currant jelly like sputum
Klebsiella radiographic clues
-extensive lobar consolidation
-bulging fissure sign
-cavitary lesions (gas filled space in an area of consolidation)
Tx of Klebsiella pneumonia
*resistant to all of the big gun abx
-use impenem-cilastatin or meropenem
Legionella PNA sx
-GI sx (esp. diarrhea)**(ONLY pna to have diarrhea sx)
-neurologic findings (esp. confusion)
Gram stain of respiratory secretions shows many neutrophils, but few, if any microorganisms.
-failure to respond to beta-lactam and/or aminoglycoside abx
Is legionella transmitted from person to person??
Treatment of legionella?
-nope, from contaminated water supply
-tx is macrolides of respiratory FQ
Staphylococcus aureaus pna
-commonly shows up when?
-what bacteria is this?
-MRSA associated with?
-often seen post influenza
-group A streptococcus (GAS; S, pyogenes)
-MRSA associated with high mortality and necrotizing pneumonia
Pseudomonas aeruginosa pneumonia
-how does their breath smell?
-cough productive of purulent sputum, dyspnea, fever, chills, confusion, and sever systemic toxicity
-sweet, grape-life odor of breath
Risk factors of Pseudomonas aeruginosa pna?
-bronchiectasis (cystic fibrosis)
-repeated abx use
-prolonged oral glucocorticoid use in pts w/ structural lung disease (COPD)
General treatment for NAP?
-Start with imipenem** or meropenem
--suspect legionelle add on levofloxacin or moxifloxacin
--if suspect MRAS add on Vancomycin
-if suspect pseudomonas : imipenem* or cefepime or zosyn + cipro* or tobramycin