Pulmonology Book


Nosocomial Pneumonia

Aka: Nosocomial Pneumonia, Hospital Acquired Pneumonia, Healthcare Associated Pneumonia, HCAP
  1. See Also
    1. Pneumonia
    2. Ventilator-Associated Pneumonia
  2. Epidemiology
    1. Complicates up to 1% of hospitalizations
    2. Mortality: 30-50%
  3. Indications
    1. See Healthcare Associated Multidrug Resistance Risk in Pneumonia (MDR Score)
    2. See Drug Resistance in Pneumonia Score (DRIP Score)
  4. 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
  5. Causes
    1. Aspiration following Cerebrovascular Accident (CVA)
      1. Streptococcus Pneumoniae
      2. Anaerobic Bacteria
    2. Mechanical Ventilation
      1. Coliform Bacteria (Gram Negative Bacteria)
      2. Pseudomonas aeruginosa (most common)
      3. Staphylococcus aureus (consider MRSA)
    3. Organ Failure
      1. Coliform Bacteria (Gram Negative Bacteria)
    4. Air Conditioner Contamination
      1. Legionella pneumonia
    5. Airway Obstruction
      1. Anaerobic Bacteria
    6. Corticosteroid use
      1. Yeast
      2. Pneumocystis carinii Pneumonia
    7. Neutropenia (<500 Neutrophils/mm3)
      1. Aspergillus
      2. Candidiasis
  6. Symptoms
    1. Fever
    2. Purulent Sputum
  7. Labs
    1. Complete Blood Count
      1. Leukocytosis
    2. Arterial Blood Gas
      1. Increased A-a Gradient
  8. Imaging: Chest XRay
    1. New or progressive lung infiltrate
  9. 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
  10. References
    1. Gilbert (2016) Sanford Antimicrobial, accessed IOS app 12/6/2016
    2. Bowton (1999) Chest 115:28S-33S [PubMed]
    3. Cunha (2001) Med Clin North Am 85(1):79-114 [PubMed]
    4. Kollef (1999) Clin Chest Med 20(3):653-70 [PubMed]
    5. Weber (1999) Chest 115:34S-41S [PubMed]

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
Derived from the NIH UMLS (Unified Medical Language System)

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
Derived from the NIH UMLS (Unified Medical Language System)

You are currently viewing the original 'fpnotebook.com\legacy' version of this website. Internet Explorer 8.0 and older will automatically be redirected to this legacy version.

If you are using a modern web browser, you may instead navigate to the newer desktop version of fpnotebook. Another, mobile version is also available which should function on both newer and older web browsers.

Please Contact Me as you run across problems with any of these versions on the website.

Navigation Tree