Term
| health care associated pneumonia (HCAP) |
|
Definition
2+ days in hospital within 90 days
reside in nursing home or long term care facility
recent IV antibiotics, chemotherapy, or wound care within 30 days
attend a hospital or hemodialysis clinic
home infusion therapy (including antibiotics)
chronic dialysis within 30 days
home wound care
family member with MDR pathogen |
|
|
Term
| hospital acquired pneumonia (HAP) |
|
Definition
>/= 48 hours after admission to the hospital
early onset = within 4 days of admission
late onset = > 4 days after admission |
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Term
ventilator associated pneumonia (VAP)
patients requiring intubation for severe HAP should be managed similar to VAP |
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Definition
>/= 48-72 hours after intubation
patients requiring intubation for severe HAP should be managed similar to VAP |
|
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Term
advanced age
immunocompromised
smokers
chronic medical conditions: COPD, CHF, CAD, DM, end stage kidney disease, malignancy, neurological d/o, seizure d/o, liver disease |
|
Definition
| non modifiable risk factors for nosocomial pnuemonia |
|
|
Term
intubation and mechanical ventilation
aspiration, body positioning, and enteral feedings
modulation of colonization
stress ulcer prophylaxis
transfusion
glucose control |
|
Definition
| modifiable risk factors for nosocomial pneumonia |
|
|
Term
antimicrobial therapy within 90 days
late onset HAP - current hospitalization for >/= 5 days
high frequency of antibiotic resistance in community or hospital
immunosuppressive therapy or disease
HCAP
presence of risk factors for HCAP: 2 day hospitalization w/in 90 days, nursing home or long term care facility, home infusion therapy (including antibiotics), chronic dialysis w/in 90 days, home wound care, family member with MDR pathogens |
|
Definition
| identify risk factors for multi drug resistant pathogens |
|
|
Term
CASH SPEKS
Citrobacter spp.
Acinetobacter baumanii
Staphylococcus aureus
H. influenzae
Streptococcus pnuemoniae
Pseudomonas aeruginosa
Enterobacter spp.
Klebsiella pneumoniae
Serratia spp. |
|
Definition
| identify pathogens that are likely to produce multi-drug resistant strains |
|
|
Term
general recommendations: staff education, compliance with hand hygiene practices, isolation procedures, hospital and unit based microbial surveillance
non-invasive positive pressure ventilation
reduce duration of mechanical ventilation
aspiration reduction
decrease oropharyngeal colonization
decreased use of acid suppression medications
decrease blood transfusions
glucose control |
|
Definition
| prevention strategies for nosocomial pneumonia |
|
|
Term
Streptococcus pneumoniae
Haemophilus influenzae
MSSA
sensitive enteric gram - bacilli (E. coli, Klebsiella, Enterobacter, Proteus, Serratia) |
|
Definition
| possible pathogens for early onset HAP (4 days or less) and NO risk factors for MDR pathogens |
|
|
Term
Streptococcus pneumonia
Haemophilus influenzae
Pseudomonas aeruginosa
ESBL enteric gram - bacilli (E. coli, Klebsiella, Enterobacter, Proteus, Serratia)
Acinetobacter
MRSA
Legionella pneumophilia |
|
Definition
| possible pathogens for late onset HAP (> 4 days) or VAP or HCAP and/or risk factors for MDR pathogens |
|
|
Term
ampicillin/sulbactam
OR
ceftriaxone
OR
ertapenem
OR
levofloxacin; moxifloxacin |
|
Definition
| appropriate emperic therapy for early onset HAP (4 days or less) and NO risk factors for MDR pathogens |
|
|
Term
antipseudomonal beta-lactam/beta-lactamase inhibitor (piperacillin, ticaracillin) OR antipseudomonal cephalosporin (cefepime or ceftazidime) OR antipseudomonal carbapenem (doripenem, meropenem, imipenem)
PLUS
antipseudomonal fluoroquinolone (ciprofloxacin, levofloxacin) OR aminoglycoside
PLUS
vancomycin or linezolide (for MRSA) |
|
Definition
| appropriate empiric treatment for late onset HAP (> 4 days) or VAP or HCAP and/or risk factors for MDR pathogens |
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