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H CAP & H AP Pamela Charity, MD Cathryn Caton, MD, MS.

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Presentation on theme: "H CAP & H AP Pamela Charity, MD Cathryn Caton, MD, MS."— Presentation transcript:

1 H CAP & H AP Pamela Charity, MD Cathryn Caton, MD, MS

2 O BJECTIVES Define pneumonia Define HAP and review the characteristics Define HCAP Diagnosing HCAP and HAP Treatment of HCAP and HAP Review treatment algorithm

3 P NEUMONIA Fever Leukocytosis Infiltrate on CXR

4 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

5 H OSPITAL A CQUIRED P NEUMONIA Time of onset Is an epidemiologic variable and Risk factor for specific pathogens and Affects outcomes

6 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

7 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

8 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

9 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.

10 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

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13 C HOOSING E MPIRIC A NTIBIOTICS

14 D E - ESCALATION OF A NTIBIOTIC T HERAPY This may be appropriate if Clinical improvement at 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 hours and cultures are negative

15 T REATMENT A LGORITHM

16 R EFERENCES ATS/IDSA Guidelines Am J Respir Crit Care Med Vol 171. pp , 2005


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