Nosocomial Pneumonia (HAP)

Question 1

Nosocomial pneumonia (Hospital Acquired Pneumonia)

Answer 1

Definition
Pneumonia occurs ≥48h after admission to hospital and was not present before admission.

Question 2

Organisms causing Nosocomial pneumonia (Hospital Acquired Pneumonia)

Answer 2

1-Staph aureus including MRSA, MSSA
2- G-ve bacilli as :
*Pseudomass Aeruginosa
* Klebsiella pneumoniae
* E. Colic

Question 3

Diagnostic criteria

Answer 3

1-Clinical Symptoms of Pneumonia: Fever, cough
+
2- Hypoxia
+
3- new radiological infiltrate developed at least 48h after hospital admission
+
Positive Sputum Cultures

Question 4

Infectious causes of nosocomial fever
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Answer 4

According to CDC, the most common causes are:
1. Central line associated blood stream infection:
• which is caused by s.aureus, s.epidermidis, gram -ve bacteria. Candida
in immunocompromised patients
2. Catheter associated urinary tract infection:
• which is caused by klebsiella, E. coli in patients with prolonged bladder
catheterization.
3. surgical site infection
• which most commonly caused by streptococcus pyogenes, S.aureus,
MRSA, pseudomonus, E.coli, klebsiella.
4. Ventilator associated and hospital acquired pneumonia (HAP), (VAP):
• which is caused by MRSA. Pseudomonus, enterobacter, klebsiella.
• to differentiate colonization from true infection:
- Presence of a single organism in gram stain combined with more than
10 neutrophils HPF.
- New infiltrate in chest X-ray.
- Reduction in pao2.
- Procalcitonin level.
5. Clostridium difficile infection.
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6. Other causes according to the affected system include:
- Sinusitis.
- Otitis media.
- Throat infection
- Ocular infection.
- Skin, soft tissue infection.
- Cardiac infection.
- Another respiratory tract infection.
- Bone and joint infection.
- CNS infection.
- Genital tract infection.

Question 5

Non-infectious causes of nosocomial fever?
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سؤال امتحان
قول non infectious causes of fuo
+ نقل الدم والدوا

Answer 5

1. Malignancy
   ▪ Lymphoma.
   ▪ Leukaemia.
   ▪ Renal cell carcinoma
   ▪ Primary hepatoma.
   ▪ Atrial myxoma.
2. Autoimmune diseases:
   ▪ SLE.
   ▪ Still disease.
   ▪ Polyarteritis nodosa.
   ▪ Hypersensitivity angiitis.
   ▪ Polymyalgia rheumatica.
   ▪ Mixed connective tissue diseases.
   ▪ Subacute thyroiditis.
3. DVT
   ▪ Pulmonary embolism.
   ▪ Intracerebral haemorrhage.
4. Drug induced:
   ▪ Antihistaminic, barbiturate, phenytoin, hydralazine, Thiouracil.
5. Reabsorption of hematoma.
6. Familial Mediterranean fever.
7. Post transfusion e.g.: blood transfusion.
8. Factitious fever.

Question 6

Discuss clinical presentation and diagnosis of central line associated blood stream infections (CLABSI)
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