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Nosocomial Pneumonia
Aka: Nosocomial Pneumonia, Hospital Acquired Pneumonia, Healthcare Associated Pneumonia, HCAP
- See Also
- Pneumonia
- Ventilator-Associated Pneumonia
- Epidemiology
- Complicates up to 1% of hospitalizations
- Mortality: 30-50%
- Indications
- See Healthcare Associated Multidrug Resistance Risk in Pneumonia (MDR Score)
- See Drug Resistance in Pneumonia Score (DRIP Score)
- 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
- Causes
- Aspiration following Cerebrovascular Accident (CVA)
- Streptococcus Pneumoniae
- Anaerobic Bacteria
- 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
- Legionella pneumonia
- Airway Obstruction
- Anaerobic Bacteria
- Corticosteroid use
- Yeast
- Pneumocystis carinii Pneumonia
- Neutropenia (<500 Neutrophils/mm3)
- Aspergillus
- Candidiasis
- Symptoms
- Fever
- Purulent Sputum
- Labs
- Complete Blood Count
- Leukocytosis
- Arterial Blood Gas
- Increased A-a Gradient
- Imaging: Chest XRay
- New or progressive lung infiltrate
- 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
- 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]