Diese Präsentation wurde erfolgreich gemeldet.
Wir verwenden Ihre LinkedIn Profilangaben und Informationen zu Ihren Aktivitäten, um Anzeigen zu personalisieren und Ihnen relevantere Inhalte anzuzeigen. Sie können Ihre Anzeigeneinstellungen jederzeit ändern.

Hospital acquired pneumonia

Hospital acquired pneumonia

  • Loggen Sie sich ein, um Kommentare anzuzeigen.

Hospital acquired pneumonia

  1. 1. Hospital Acquired Pneumonia
  2. 2. • Definition : Pneumonia developing >48 hours after hospital admission • Etiology : organisms that colonize the pharynx of the hospitalized, critically ill patient. 1. S. aureus 2. enteric (eg: K. pneumoniae or E. coli) 3. nonenteric (eg: P. aeruginosa) gram-negative bacilli * Patients with longer lengths of hospital admission or IV antibiotic use within the previous 90 days prior to the development of HAP are more likely to have MDR organisms.
  3. 3. • Risk Factors : • Witnessed aspiration • COPD, ARDS, or coma • Administration of antacids, H2-antagonists, or proton pump inhibitor • Supine position • Enteral nutrition, nasogastric tube • Reintubation, tracheostomy, or patient transport • Head trauma, ICP monitoring • Age >60 years • MDR risk (eg: MRSA, MDR Pseudomonas) if IV antibiotic use within 90 days
  4. 4. • Diagnosis of HAP: 1. Presence of a new infiltrate on chest radiograph, 2. Fever 3. worsening respiratory status 4. the appearance of thick, neutrophil-laden respiratory secretions
  5. 5. Treatment • Empirically : 1- MSSA & MRSA • If Patient have risk for MRSA infection ,we recommend vancomycin or linezolid rather than an alternative antibiotic • For patients with HAP who are being treated empirically and have no risk factors for MRSA infection and are not at high risk of mortality ,regimen including piperacillin- tazobactam, cefepime, levofloxacin, imipenem, or meropenem *Oxacillin, nafcillin, or cefazolin
  6. 6. 2- For patients with HAP who are being treated empirically and have factors increasing the likelihood for Pseudomonas or other gram-negative infection we suggest prescribing antibiotics from 2 different classes with activity against P. aeruginosa, BUT All other patients with HAP who are being treated empirically may be prescribed a single antibiotic with activity against P. aeruginosa.
  7. 7. • Pathogen specific treatment : 1- MRSA either vancomycin or linezolid 2- PA Double coverage (risk factors): i. patients in units where >10% of gram-negative isolates are resistant to an agent being considered for monotherapy, ii. structural lung disease( bronchiectasis or cystic fibrosis) iii. ICU Patients iv. if IV antibiotic use within 90 days v. Septic Shock
  8. 8. 3- Acinetobacter Species: I. treatment with either a carbapenem or ampicillin/sulbactam if the isolate is susceptible to these agents II. we recommend intravenous polymyxin (colistin or polymyxin B),If Acinetobacter species that is sensitive only to polymyxins III. Acinetobacter species that is sensitive only to colistin, we suggest not using adjunctive rifampicin IV. HAP/VAP caused by Acinetobacter species, we recommend against the use of tigecycline 4-Carbapenem-Resistant Pathogens : we recommend intravenous polymyxins (colistin or polymyxin B) ,IF carbapenem-resistant pathogen that is sensitive only to polymyxins
  9. 9. • Duration of therapy : we recommend a 7-day course of antimicrobial therapy shorter or longer duration of antibiotics may be indicated, depending upon the rate of improvement of clinical, radiologic, and laboratory parameters
  10. 10. HAP Usual Pathogens Empirical Therapy No risk factors for MDR pathogens (single agent Pseudomonal coverage) S. pneumoniae, H. influenzae, MSSA, enteric gram- negative bacilli Piperacillin/tazobactam Cefepime levofloxacin, imipenem Meropenem Risk factors for MDR pathogen (dual agent Pseudomonal coverage) P. aeruginosa, K. pneumoniae (ESBL), Acinetobactersp. If MRSA or Legionella sp. suspected Antipseudomonal cephalosporine or antipseudomonal carbapenem or β-lactam/β-lactamase + antipseudomonal fluoroquinoloned or AMGg Above + vancomycin or linezolid
  11. 11. THE END

×