Pneumonia Pathophysiology 2012 (1)

Admission not incubating at admission early onset 5

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admission not incubating at admission Early onset: < 5 days from admission* Late onset: ≥ 5 days from admission Ventilator associated pneumonia (VAP) Pneumonia ≥ 48-72 hours following endotracheal intubation Determining Potential Microbiologic Causes *Pathogen prevalence resembles CAP – antibiotic choices should include coverage for CAP pathogens
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Microbiology and Pathogen Prevalence Staphylococcus aureus 10% Pseudomonas aeruginosa 8% Klebsiella pneumonia 4% Escherichia coli 2% Enterobacter species 5% Acinetobacter baumannii 2% Pathogen** Prevalence Hospital* and Ventilator Associated Pneumonia *Late onset HAP **Empiric antibiotics should provide coverage for each of these pathogens
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Microbiology and Pathogen Prevalence Hospital and Ventilator Associated Pneumonia Pseudomonas aeruginosa Gram negative bacilli (rods) Non-lactose fermenting Infections Hospital associated HAP and VAP UTI, bacteremia Post-neurosurgical meningitis Foliculitis (hot tubs) Often multi-drug resistant
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Key Steps for Evaluating Pneumonia Healthcare associated pneumonia (HCAP) Pneumonia developing in a patient with 1 or more of the following criteria: Previous hospitalization (within 90 days) Residence in a nursing home Received antibiotics (within 30 days) Received chemotherapy (within 30 days) Received wound care (within 30 days) Attends a hemodialysis clinic Patients may be at risk for hospital associated pathogens or drug resistant pathogens Determining Potential Microbiologic Causes
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Hospitalization Day 1 Day 2 Day 3 Day 4 Day 5 CAP* HAP Early* Late Key Steps for Evaluating Pneumonia Determining Potential Microbiologic Causes *Patient is likely to have CAP pathogens, unless risk factors for HCAP are present
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Key Steps in the Evaluation and Management of Pneumonia 1. Consider clinical presentation 1. Evaluate diagnostic tests and lab values 3. Determine the organisms most likely to be causing the infection 4. Choose appropriate antibiotic therapy 5. Provide appropriate monitoring of therapeutic interventions
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Questions ???
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