II. Epidemiology
- Complicates up to 1% of hospitalizations
- Mortality: 30-50%
III. Indications
IV. Background
- As of 2016, IDSA has dropped HCAP designation
- HCAP had a broad definition (hospital, Nursing Home, home care in prior 90 days)
- Broad definition poorly identified multidrug resistance, and resulted in overuse of broad Antibiotics
- Designations
- Community Acquired Pneumonia (CAP)
- Ventilator Associated Pneumonia (VAP)
- Hospital Acquired Pneumionia (HAP)
- Pneumonia onset within 48-72 hours after hospitalization
- Antibiotic coverage broadened to include MRSA
V. Causes
- Aspiration following Cerebrovascular Accident (CVA)
-
Mechanical Ventilation
- Coliform Bacteria (Gram Negative Bacteria)
- Pseudomonas aeruginosa (most common)
- Staphylococcus Aureus (consider MRSA)
- Organ Failure
- Coliform Bacteria (Gram Negative Bacteria)
- Air Conditioner Contamination
- Airway Obstruction
- Corticosteroid use
- Neutropenia (<500 Neutrophils/mm3)
VI. Symptoms
VII. Labs
VIII. Imaging: Chest XRay
- New or progressive lung infiltrate
IX. Management: Empiric Regimen
-
Antibiotic 1 for MRSA coverage (choose one)
- Vancomycin 15-20 mg/kg IV every 8-12 hours (preferred) or
- Linezolid 600 mg IV every 12 hours
-
Antibiotic 2 (choose one)
- Cefepime 2 g IV every 12 hours or
- Meropenem 1 g every 8 hours or
- Piperacillin-Tazobactam (Zosyn) 4.5 g every 6 hours
- Additional Antibiotics to add to empiric regimen as indicated
- Increased local resistance rates
- Tobramycin 5-7 mg/kg IV every 24 hours or
- Levofloxacin 750 mg IV every 24 hours or
- Ciprofloxacin 400 mg IV every 8 hours or
- Amikacin 15-20 mg/kg IV every 24 hours
- Legionella suspected
- Azithromycin 500 mg IV every 24 hours OR
- Broad spectrum Fluoroquinolone
- Trovafloxacin 300 mg IV q24 hours
- Levofloxacin 500 mg IV q24 hours
- Increased local resistance rates
X. References
- Gilbert (2016) Sanford Antimicrobial, accessed IOS app 12/6/2016
- Bowton (1999) Chest 115:28S-33S [PubMed]
- Cunha (2001) Med Clin North Am 85(1):79-114 [PubMed]
- Kollef (1999) Clin Chest Med 20(3):653-70 [PubMed]
- Weber (1999) Chest 115:34S-41S [PubMed]
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Related Studies
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 |