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Nosocomial Pneumonia

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Nosocomial Pneumonia, Hospital Acquired Pneumonia, Healthcare Associated Pneumonia, HCAP

  • Epidemiology
  1. Complicates up to 1% of hospitalizations
  2. Mortality: 30-50%
  • 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
  • Causes
  1. New or progressive lung infiltrate
  • 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