H OSPITAL A CQUIRED P NEUMONIA Category of pneumonia that occurs 48 hours or more after admission Encompasses healthcare associated pneumonia and ventilator associated pneumonia
H OSPITAL A CQUIRED P NEUMONIA Time of onset Is an epidemiologic variable and Risk factor for specific pathogens and Affects outcomes
H OSPITAL A CQUIRED P NEUMONIA Early onset Within first 4 days Better prognosis More likely to be caused by antibiotic-sensitive bacteria Above is true unless patient Received prior antibiotics Have had prior hospitalization within 90 days Greater risk for colonization and infection with MDR pathogens
H OSPITAL A CQUIRED P NEUMONIA Late onset 5 days or more More likely to be caused by MDR pathogens risk factors for MDR Antimicrobial therapy in preceding 90 days Presence of risk factors for HCAP Immunosuppresive disease/therapy Increased morbidity and mortality
H EALTHCARE A SSOCIATED P NEUMONIA Category of pneumonia in patients with recent close contact with the health care system Hospitalized for 2 or more days within last 90 days Resides in nursing home or long-term care facility Received recent IV antibiotic therapy, chemotherapy, or wound care within past 30 days Hemodialysis
M AKING THE D IAGNOSIS History – this will determine the classification of pneumonia Physical exam findings Laboratory data Radiographic findings Antibiotics should be initiated within 4 hours of making the diagnosis.
C HOOSING E MPIRIC A NTIBIOTICS HCAP and HAP are treated similarly Think about multi-drug resistant pathogens Gram Neg Pseudomona Aeruginosa – some are only sensitive to polymyxin B Serratia Marcescens Klebsiella Enterobacter Acinetobacter Gram Positive MRSA VRE
D E - ESCALATION OF A NTIBIOTIC T HERAPY This may be appropriate if Clinical improvement at 48-72 hours Cultures are positive Treat for 7-8 days and reassess patient Single agent such as moxifloxacin may be appropriate May stop antibiotics if clinical improvement at 48-72 hours and cultures are negative