Term
| Definition of Health-Care Associated Pneumonia (HCAP) |
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Definition
- +2 days in hospital within 90 days
- Reside in nursing home of long-term care facility
- Recent IV antibiotics, chemotherapy, or wound care within 30 days
- Attend a hospital or hemodialysis clinic
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Term
| Definition of Hospital Associated Pneumonia (HAP) |
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Definition
> 48 hrs after admission
early onset: within 4 days of admission
late onset: > 4 days after hospital admission |
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Term
| Definition of Ventilator Associated Pneumonia (VAP) |
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Definition
- > 48-72 hrs after intubation
- Patients requiring intubation for severe HAP should be managed similar to VAP
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Term
| Non-Modifiable Risk Factors for Nosocomial Pneumonia |
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Definition
- Advanced Age
- Immunocompromised
- Smokers
- Chronical Medical Conditions (COPD, CHF, CAD, DM, ESRD, Malignancy, Neurological d/o, liver dz)
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Term
| Modifiable Risk Factors for Nosocomial Pneumonia |
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Definition
- Intubation and mechanical ventilation
- Aspiration, body positioning, and enteral feeding
- Modulation of colonization
- Stress ulcer prophylaxis
- Transfusion
- Glucose control
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Term
| What type of pathogens (antibiotic sensitive or resistant) are generally associated with early-onset HAP? |
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Definition
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Term
| What type of pathogens (antibiotic sensitive or resistant) are generally associated with late-onset HAP? |
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Definition
- Multi-Drug Resistant pathogens are associated with late-onset HAP
- Antimicrobials must target MDR pathogens
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Term
| Risk Factors for Multi-Drug Resistant (MDR) Pathogens |
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Definition
- Antimicrobial therapy within 90 days
- Late-onset HAP or HCAP
- High frequency of antibiotic resistance in the community or the hospital
- Immunosuppressive therapy or disease
- Presence of risk factors for HCAP, such as:
2 days hospitalization w/i 90 days
Nursing home or LTCF
Home infusion therapy (including abx)
Chronic dialysis w/i 30 days
Home wound care
Family member with MDR pathogen
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Term
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Definition
- Pseudomonas aeruginosa (most common MDR G-, intrinsic resistance to multiple agents)
- Klebsiella pneumoniae
- Enterobacter, Serratia, Citrobacter spp.
- Acinetobacter baumanii
- Staphylcoccus aureus
- Streptococcus pneumoniae
- H. influenzae
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Term
| Potential Pathogens of Early Onset HAP |
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Definition
- Strep. pneumoniae
- H. influenzae
- MSSA
Sensitive G- Enteric Bacilli, such as:
- E. coli
- Klebsiella
- Enterobacter
- Proteus
- Serratia
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Term
| Potential Pathogens of Late Onset HAP |
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Definition
- P. aeruginosa
- ESBL Enter G- Bacilli (E. coli, Klebsiella, Enterobacter, Proteus, Serratia)
- Acinetobacter
- MRSA
- Legionella pneumophilia
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Term
| Recommended Antibiotics for Early Onset Nosocomial Pneumonia Pathogens |
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Definition
Ceftriaxone
Or
Levofloxacin; Moxifloxacin
Or
Ampicillin/Sulbactam
Or
Ertapenem
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Term
| Recommended Antibiotics for Late Onset Nosocomial Pneumonia Pathogens |
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Definition
3 Antibiotics MUST be used prior to narrowing down spectrum: once you have determined the pathogens involved, then you can narrow therapy
Antipseudomonal Cephalosporin
Or
Antipseudomonal Carbapenem
Or
Beta-Lactam/Beta-Lactamase Inhibitor
PLUS
Antipseudomonal Fluoroquinolone
Or
Aminoglycoside
PLUS
Vancomycin
Or
Linezolid |
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