II. Epidemiology

  1. Complicates up to 1% of hospitalizations
  2. Mortality: 30-50%

IV. Background

  1. As of 2016, IDSA has dropped HCAP designation
    1. HCAP had a broad definition (hospital, Nursing Home, home care in prior 90 days)
    2. Broad definition poorly identified multidrug resistance, and resulted in overuse of broad antibiotics
  2. Designations
    1. Community Acquired Pneumonia (CAP)
    2. Ventilator Associated Pneumonia (VAP)
    3. Hospital Acquired Pneumionia (HAP)
      1. Pneumonia onset within 48-72 hours after hospitalization
      2. Antibiotic coverage broadened to include MRSA

VI. Symptoms

VIII. Imaging: Chest XRay

  1. New or progressive lung infiltrate

IX. Management: Empiric Regimen

  1. Antibiotic 1 for MRSA coverage (choose one)
    1. Vancomycin 15-20 mg/kg IV every 8-12 hours (preferred) or
    2. Linezolid 600 mg IV every 12 hours
  2. Antibiotic 2 (choose one)
    1. Cefepime 2 g IV every 12 hours or
    2. Meropenem 1 g every 8 hours or
    3. Piperacillin-Tazobactam (Zosyn) 4.5 g every 6 hours
  3. Additional antibiotics to add to empiric regimen as indicated
    1. Increased local resistance rates
      1. Tobramycin 5-7 mg/kg IV every 24 hours or
      2. Levofloxacin 750 mg IV every 24 hours or
      3. Ciprofloxacin 400 mg IV every 8 hours or
      4. Amikacin 15-20 mg/kg IV every 24 hours
    2. Legionella suspected
      1. Azithromycin 500 mg IV every 24 hours OR
      2. Broad spectrum Fluoroquinolone
        1. Trovafloxacin 300 mg IV q24 hours
        2. Levofloxacin 500 mg IV q24 hours

Images: Related links to external sites (from Bing)

Related Studies

Ontology: Nosocomial pneumonia (C0949083)

Concepts Disease or Syndrome (T047)
SnomedCT 425464007
Dutch nosocomiale pneumonie
French Pneumonie nosocomiale
German nosokomiale Pneumonie
Italian Polmonite nosocomiale
Portuguese Pneumonia nosocomial
Spanish Neumonia nosocomial, neumonía nosocomial, neumonía hospitalaria (trastorno), neumonía hospitalaria
Japanese 院内肺炎, インナイハイエン
English Nosocomial pneumonia (disorder), Hospital acquired pneumonia, Nosocomial pneumonia, hospital-acquired pneumonia, hospital-acquired pneumonia (diagnosis), pneumonia hospital acquired, hospital acquired pneumonia, acquired hospital pneumonias, nosocomial pneumonia, nosocomial pneumonias, pneumonia nosocomial
Czech Nozokomiální pneumonie
Hungarian Nosocomialis pneumonia

Ontology: Healthcare associated pneumonia (C1443237)

Concepts Disease or Syndrome (T047)
SnomedCT 408679000
English Healthcare associated pneumonia (diagnosis), pneumonia healthcare associated, Healthcare associated pneumonia (disorder), Healthcare associated pneumonia
Spanish neumonía asociada con la atención médica (trastorno), neumonía asociada con la atención médica