Hospital Acquired Pneumonia - PowerPoint PPT Presentation

Loading...

PPT – Hospital Acquired Pneumonia PowerPoint presentation | free to download - id: 3cf54f-ODg3O



Loading


The Adobe Flash plugin is needed to view this content

Get the plugin now

View by Category
About This Presentation
Title:

Hospital Acquired Pneumonia

Description:

... and any disease severity Streptococcus pneumoniae MSSA Haemophilus influenzae Klebsiella pneumoniae Enterobacter Escherichia coli Acinetobacter Has risk ... – PowerPoint PPT presentation

Number of Views:187
Avg rating:3.0/5.0
Slides: 13
Provided by: medicineU8
Category:

less

Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: Hospital Acquired Pneumonia


1
Hospital Acquired Pneumonia
2
Definitions
  • Community acquired pneumonia (CAP)
  • Infection of the lung parenchyma in a person who
    is not hospitalized or living in a long-term care
    facility for 2 weeks
  • Hospital-acquired pneumonia (HAP)
  • Occurs 48 hours or more after admission, which
    was not incubating at the time of admission
  • Healthcare-associated pneumonia (HCAP) is defined
    as pneumonia that occurs in a non-hospitalized
    patient with extensive healthcare contact, as
    defined by one or more of the following
  • Intravenous therapy, wound care, or intravenous
    chemotherapy within the prior 30 days.
  • Residence in a nursing home or other long-term
    care facility
  • Hospitalization in an acute care hospital for two
    or more days within the prior 90 days
  • Attendance at a hemodialysis clinic within the
    prior 30 days
  • Ventilator-associated pneumonia (VAP)
  • Arises more than 48-72 hours after endotracheal
    intubation

3
Initial Evaluation of Suspected Pneumonia
  • Common clinical features
  • Cough
  • Fever/Chills
  • Pleuritic chest pain
  • Dyspnea
  • Sputum production
  • Some may have GI symptoms including nausea,
    vomiting and diarrhea
  • Physical Exam
  • Fever
  • Respiratory Rate gt24
  • Tachycardia
  • Chest examination may reveal audible rales

4
Initial Evaluation of Suspected Pneumonia
  • A chest radiograph should be obtained in patients
    with suspected pneumonia when possible a
    demonstrable infiltrate by chest radiograph or
    other imaging technique is required for the
    diagnosis of pneumonia, according to the 2007
    consensus guidelines from the Infectious Diseases
    Society of America and the American Thoracic
    Society (IDSA/ATS)
  • The radiographic appearance of Pneumonia may
    include lobar consolidation, interstitial
    infiltrates, and/or cavitation.

5
Initial Evaluation of Suspected Pneumonia
  • The 2007 IDSA/ATS consensus guidelines recommend
    for diagnostic testing
  • For outpatients with CAP routine diagnostic tests
    are optional.
  • Hospitalized patients should have CBC w/ diff,
    blood cultures and sputum Gram stain and culture
  • Patients with severe CAP requiring ICU admission
    should have blood cultures, urinary antigen
    tests, and sputum culture (either expectorated or
    endotracheal aspirate)

6
Hospital Admission
  • There are a Severity-of-illness scores that can
    help guide whether to admit or not but should not
    be used over clinical judgment of the patient and
    situation.
  • CURB-65 criteria (gt2, more-intensive treatment)
  • Confusion
  • Urea 7 mmol/L (20 mg/dL)
  • Increased respiratory rate gt30
  • low blood pressure (SBP lt90 or DBP lt60)
  • Pneumonia Severity Index (PSI)
  • uses demographics, the coexistence of co-morbid
    illnesses findings on physical examination,
    vital signs and essential laboratory findings

7
HAP/HCAP/VAP Pathogens
American Thoracic Society, Infectious Diseases
Society of America. Guidelines for the management
of adults with hospital-acquired,
ventilator-associated, and healthcare-associated
pneumonia. Am J Respir Crit Care Med 2005
171388.
8
HAP/HCAP/VAP Pathogens
  • No known risk factors for multidrug-resistant
    pathogens, early onset, and any disease severity
  • Streptococcus pneumoniae
  • MSSA
  • Haemophilus influenzae
  • Klebsiella pneumoniae
  • Enterobacter
  • Escherichia coli
  • Acinetobacter
  • Has risk factors for Multidrug resistant
    pathogens
  • ESBL
  • Legionella pneumophila
  • MRSA
  • P aeruginosa consider especially with VAP

9
HAP/HCAP/VAP Treatment
American Thoracic Society, Infectious Diseases
Society of America. Guidelines for the management
of adults with hospital-acquired,
ventilator-associated, and healthcare-associated
pneumonia. Am J Respir Crit Care Med 2005
171388.
10
HAP/HCAP/VAP Treatment
American Thoracic Society, Infectious Diseases
Society of America. Guidelines for the management
of adults with hospital-acquired,
ventilator-associated, and healthcare-associated
pneumonia. Am J Respir Crit Care Med 2005
171388.
11
Failure to Improve
  • If patient does not improve on broad spectrum
    antibiotics may need to consider possibilities
    including Fungal Pneumonias, TB, PJP, Viral
    Pneumonias or even ARDs.

12
References
  • Mandell LA, Wunderink RG, Anzueto A, et al.
    Infectious Diseases Society of America/American
    Thoracic Society consensus guidelines on the
    management of community-acquired pneumonia in
    adults. Clin Infect Dis 2007 44 Suppl 2S27.
  • American Thoracic Society, Infectious Diseases
    Society of America. Guidelines for the management
    of adults with hospital-acquired,
    ventilator-associated, and healthcare-associated
    pneumonia. Am J Respir Crit Care Med 2005
    171388.
  • Schuetz P, Christ-Crain M, Thomann R, et al.
    Effect of procalcitonin-based guidelines vs
    standard guidelines on antibiotic use in lower
    respiratory tract infections the ProHOSP
    randomized controlled trial. JAMA 2009 3021059.
About PowerShow.com