Term
| What are important factors when it comes to differentiating pneumonia categories? |
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Definition
- Environment of patient where infection occurred
- Time when infection occurs (esp. for HAP)
- Patient factors |
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Term
| What is the definition of HAP? |
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Definition
| - Pneumonia occuring 48 hours after admission, not incubated at time of admission |
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Term
| What is the definitin of ventilator associated Pneumonia (VAP)? |
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Definition
| - Pneumonia that occurs 48-72 hours after an endotracheal intubation |
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Term
| What is the definition of HCAP? |
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Definition
Includes patients...
- Hosp. within an acute care hospital for 2 days plus days within 90 days of admission
- Residing in nursing home or long-term facility prior to admission
- Who have recieved IV antibiotics, chemo, or wound therapy within 30 days of admission
- Who attend a hospital or hemodialysis center |
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Term
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Definition
- Unlike CAP, pathogen is S. Aureus
- Need to utilize more big gun Abx
- 30-70% mortality overall
- 33%-50% attributed mortality
- increases stay at hospital and overall excess cost of 40k a patient
- Early onset is within 4 days of hospitilization. If pt. been on previosu Abx or hosp. within past 90 days, treat as late onset
- Late onset is infection occuring after 5 days, associated with MDR pathogens and high mortality |
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Term
| What causes nosocomial pneumonia? |
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Definition
| Bacteria!! Aerobic gram negative bacilli, gram positive cocci |
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Term
| Name some non-MDR pathogens |
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Definition
- Strep Pneumo
- H. Influenzae
- MSSA
- Gram negative bacilli: E. Coli, Klebsiella, Enterobactor, Proteus, Serratia |
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Term
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Definition
- Pseudomonas
- Some klebsiella, Ecoli, Enterobacter, serratia
- Acinetobacter species
- MRSA
- Legionella |
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Term
| What are the risk factors for MDR pathogens? |
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Definition
- Abx therapy in last 90 days
- Current hospitilization of greater than 5 days
- High abx resistance in surrounding persons
- Risk factors for HCAP
- Immunosuppresive disease and/or therapy |
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Term
| Everything we need to know about Pseudomonas..... |
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Definition
- Most common MDR gram negative pathogen
- High mortality, very virulent
- Highly resistant
- Know what covers this |
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Term
| Everything we need to know about acinetobacter is...... |
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Definition
- Inherent resistance to many classes of abx
- Increasing resistance seen in US
- Generally less virulent in comparison to pseudomonas
- Most effective abx against this are: Carbapenems, Ampicillin/Sulbactam, Polymixins |
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Term
| What are the Extended-spectrum B-lactamase producing Enterobacteriaceae (ESBL's) |
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Definition
- May include Klebsiella, Ecoli, Enterobacter, and Serrattia
- Typically resistant to most Abx
- Carbapenems most reliable choice
- Rate of occurence varies widely, mostly increasing though. |
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Term
| All we need to know about MRSA |
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Definition
- Over 50% of ICU infections caused by this
- Use either vancomycin or linezolid |
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Term
| How can we diagnose a MRSA patient? |
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Definition
- Chest radiograph that shows lung inflitrates
- Arteriol oxygenation measurement
- Blood culture obtainment
- Lower respiratory tract culture before Abx started or changed
- endotrachial aspirate
- Bronchoalveolar lavage
- Protected specimen brush |
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Term
| What are the general treatment guidelines (strategies) for HAP? |
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Definition
- Hit 'em hard, hit 'em early
- Broad spectrum up front
- Use combo for patients at risk for MDR pathogens
- change up Abx if ineffective after 2 weeks to reduce resistance |
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Term
| More treatment pearls for therapy |
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Definition
- Initial therapy should be IV, switch to PO on good clinical response
- Aggressive/appropriate dosing
- Pull back on therapy based on cultures and response.
- Try and shorten duration of therapy to 7 days, long if Pseudomonas or Acinetobacter |
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Term
| What would be the treatment and dosing for Non-MDR pathogens in HAP? |
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Definition
- Ceftriaxone - 1g daily
- Levo 500mg-750mg daily
- Moxi 400mg daily
- Same with Cipro but BID or TID
- Amp/Sulbactam 1.5-3g every 4-6 hours
- Ertapenem 1g daily |
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Term
| What is in the first treatment group for MDR pathogens in HAP? |
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Definition
- Cefepime 1-2g q8-12 hours
- Ceftazidime 2g q8 hours
- Imipenem 500mg q6 hours or 1g q8hours
- Meropenem 1g q8 hours
- Piper/Tazo 4.5g q6 hours
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Term
| What is in the second treatment group for MDR pathogens in HAP? |
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Definition
- Gentamicin 7mg/kg daily
- Same with Toby
- Amikacin 20mg/kg daily
- Levo 750mg daily
- Cipro 400mg q8 hours
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Term
| What is in the third treatment group for MDR pathogens in HAP? |
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Definition
- Vancomycin 15mg/kg daily q12 hours
- Linezolid 600mg q12 hours |
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Term
| What's an example of combo therapy, and when should it be used in HAP? |
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Definition
- For combo therapy, use one Abx from each group
- Use for synergy, decrease resistance
- Use in MDR patients
- Otherwise, monotherapy is adequate |
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Term
| How long should the duration of therapy be for HAP patients? |
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Definition
- Most Abx killing and improvements seen in first 6 days
- Long duration can increase resistance, more bacteria
- Try and do 7 days unless Pseudomonas or Acinetobacter
- Do NOT alter therapy for 3 days, improvements seen in 48 hours
- At day 3, if patient is responding, continue. If not responding, broaden coverage or make another diagnosis |
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