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Flashcards in Nosocomial Pneumonia Deck (29):
1

Nosocomial pneumonia:
3 types?

Hospital-acquired pneumonia (HAP)
Ventilator associated pneumonia (VAP)
Health care associated pneumonia (HCAP)

2

HAP definition?


VAP definition?

Develops more than 48 hours after admission to the hospital

Development of pneumonia in a mechanically ventilated patient 48 hours after endotracheal intubation

3

HCAP definition?

Development of pneumonia in an outpatient setting in an individual with extensive health care contact

4

Mortailty of nosocomial pneumonia?

20-50%

5

Risk factors for HCAP?
8

1. Antibiotics in the last 3 months
2. Hospitalization in the last 3 months of at least 2 days duration
3. Resident of a nursing home or extended care facility
4. Home infusion therapy within the last month
5. Long term dialysis
6. Home wound care
7. Family member with an infection involving a multiple drug resistant pathogen
8. Immunosuppression (disease or therapy)

6

What is different from CAP?
4

1. Change in normal flora
--Flora develops different resistance patterns
2. Different pathogens
3. High frequency of drug resistance
4. Patient’s have worse underlying health status

7

Pathophysiology
of nosocomial: Where does the bacteria colonize and why?

Colonization of the stomach and pharynx

Nasogastric tube

8

Organisms that cause nasocomial pneumonia?
5

1. Streptococcus pneumonia
--Often drug resistant
2. Staphlococcus aureus
--MSSA and MRSA
3. Gram negative rods
--Non-ESBL
--ESBL : Klebsiella pneumonia, Escherichia coli and Enterobacter
4. Pseudomonas aeruginosa
5. Acinetobacter species

9

Bugs mostly causing HAP?
5

Staphlococcus aureus
Pseudomonas aeruginosa

Gram negative rods
-Enterobacter
-Klebsiella pneumoniae
-Escherichia coli

10

Bugs mostly causing VAP?
5
Whats the most common?

MRSA 18%
P. aeruginosa 18%
MSSA 9%
Stenotrophomonas maltophilia 7%
Acinetobacter spp 8%

11

HCAP Common organisms that are more likely to be?

drug resistant

12

Signs and symptoms
of noscomial pneumonia?

Same as with community acquired pneumonia but more severe

13

Diagnostic clues
for Streptococcus pneumoniae?

Rust-colored sputum

14

Diagnostic clues Pseudomonas, Haemophilus, and pneumococcal species?

May produce green sputum

15

Diagnostic clues for Klebsiella species pneumonia?

Red currant-jelly sputum

16

Diagnostic clues for Anaerobic infections:

Often produce foul-smelling or bad-tasting sputum

17

Klebsiella pneumonia
risk factors?
3

Elderly
Alcoholics
Debilitated hospital pts

18

Klebsiella pneumonia
features:

What group of bacteria is it part of?

What can it cause?

What is seen on the XRAy?
3

Gram negative member of Enerobacteriacae

Can cause extensive pulmonary necrosis

1. Cavitations seen on xray
2. Abscess formation (empyema)
3. Pleural adhesions

19

Klebsiella pneumonia
clinical manifestations:

Onset?
Symtpoms?
Cough?

Rapid onset of severe symptoms

Flulike symtpoms (fever and chills)

Productive of current jelly

20

Klebsiella radiographic clues?
4

1. Extensive lobar consolidation
2. Air bronchograms
3. Bulging fissure sign
4. Cavitary lesions (gas filled space in an area of consolidation)

21

Treatment of Klebsiella pneumonia?
2

Usually extended spectrum beta-lactamase positive so resistant to B-lactam and B-lactamase inhibitors, co-resistance to all FQs and often aminoglycosides

SOOOOOO

Imipenem-cilastatin
Meropenem

22

Legionella characteristics

1. GI symptoms, especially diarrhea
2. Neurologic findings, especially confusion
3. Fever >39ºC
4. Gram stain of respiratory secretions shows many neutrophils, but few, if any, microorganisms
5. Hyponatremia
6. Hepatic dysfunction
7. Hematuria
8. Failure to respond to beta-lactam and/or aminoglycoside antibiotics

23

How is legionella spread?

Treatment?2

Not transmitted from person to person
From contaminated water supply

Macrolides or Respiratory FQ for treatment

24

Staphlococcus aureus pneumonia is often seen when?

What infection is seen associated with high mortality and necrotizing pneumonia?

Often seen post influenza



MRSA

Can be dangerous even in young immunocomprimised questions

25

Pseudomonas aeruginosa pneumonia has what kind of symtpoms?
5


What is the characteristic odor?
Pigment?

1. Cough productive of purulent sputum,
2. dyspnea,
3. fever, chills,
4. confusion, and
5. severe systemic toxicity

Characteristic sweet, grape-like odor
Green

26

Risk factors
for pseudomonas?
5

1. Bronchiectasis (cystic fibrosis)
2. Repeated antibiotic use
3. Prolonged oral glucocorticoid use in patient’s with structural lung disease (COPD, pulmonary fibrosis)
4. Immunocompromised
5. Previous hospitalizations

27

General Treatment for Nosocomial PNA??
2

If you suspect Legionella add on what? 2

If you suspect MRSA?

If you suspect pseudomonas?
4

Imipenem or meropenem


Levofloxacin (Levaquin) or Moxifloxacin (Avelox)


Vanco


1. Imipenem (Primaxin, Tienam) or

2. cefepime (Maxipime) or

3. piperacillin-tazobactam (Zosyn) + Cipro

4. Tobramycin
ADD AN FQ, cipro

28

Prevention of nosocomial pneumonia?
7

1. Avoid acid-blocking medications
--Use sulcralfate instead in hospitalized patients
2. Decontamination of the oropharynx
3. Patient positioning
4. Subglottic drainage (special ETT)
5. Preventing aspiration
6. Handwashing
7. Clean equipment

29

Why are acid blocking meds a risk factor for pneumonia?

gets rid of all the acid in the stomach that fights that pathogenic bacteria