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Flashcards in Nosocomial Pneumonia Deck (20):
1

What is nosocomial pneumonia? What are the types of NAP?

-hospital acquired pneumonia (HAP)

Types:
-ventilator associated pneumonia (VAP)
-health care associated pneumonia (HCAP)

2

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.

3

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
-immunosuppression

4

Whats different in NAP than CAP?

NAP has:
-change in normal flora (develops different resistance patterns)
-different pathogens
-high frequency of drug resisitance
-pts have worse underlying health status

5

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.

6

Most common NAP bugs

-staphlococcus aureus
-pseudomonas aeruginosa
-gram - rods
--enterobacter
-klebsiella pneumoniae
-e. coli

7

Most common bugs causing VAP?

-MRSA
-P. aeruginosa
-MSSA
-Stenotrophomonas maltophilia
-acinetobacter

8

Signs and symptoms?

-same as community acquired pneumonia but more severe.

9

What are the diagnostic clues of each bug causing pneumonia?
-strep pneumo

-pseudomonas, haemophilus, pneumococcal

-Klebsiella

-anaerobic

strep: rust colored sputum

pseudo: green sputum

Klebsiella: red currant jelly sputum

Anaerobic: foul smelling or bad tasting sputum

10

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
-abscess formation
-(empyema)
-pleural adhesions(scar)

11

Sx of Klebsielle pneumonia?

-rapid onset of sever symptoms

-high fever and chills
-flulike sx
-cough productive of currant jelly like sputum

12

Klebsiella radiographic clues

-extensive lobar consolidation
-air bronchograms
-bulging fissure sign
-cavitary lesions (gas filled space in an area of consolidation)

13

Tx of Klebsiella pneumonia

*resistant to all of the big gun abx

-use impenem-cilastatin or meropenem

14

Legionella PNA sx
-gram stain?
-clinical findings

-GI sx (esp. diarrhea)**(ONLY pna to have diarrhea sx)

-neurologic findings (esp. confusion)

-fever >39C


Gram stain of respiratory secretions shows many neutrophils, but few, if any microorganisms.

-findings:
-hyponatremia
-hepatic dysfunction
-hematuria
-failure to respond to beta-lactam and/or aminoglycoside abx

15

Is legionella transmitted from person to person??

Treatment of legionella?

-nope, from contaminated water supply

-tx is macrolides of respiratory FQ

16

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

17

Pseudomonas aeruginosa pneumonia

-gram +/-
-sx
-how does their breath smell?

-gram negative
-cough productive of purulent sputum, dyspnea, fever, chills, confusion, and sever systemic toxicity

-sweet, grape-life odor of breath

18

Risk factors of Pseudomonas aeruginosa pna?

-bronchiectasis (cystic fibrosis)
-repeated abx use
-prolonged oral glucocorticoid use in pts w/ structural lung disease (COPD)
-immunocompromised
-prevously hospitalizations

19

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

20

Prevention of NAP?

-avoid acid-blocking meds
-decontamination of the oropharynx
-patient positioning
-subglottic drainage
-preventing aspiration
-hand washing
-clean equipment