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Mohan Gamesh
Definition
Refers to a new episode of pneumonia occurring at least 2 days (48 hours) after admission to hospital The term includes
post-operative cases certain forms of aspiration pneumonia pneumonia or bronchopneumonia developing in patients chronic lung disease general debility those receiving assisted ventilation
Early onset
Occuring <5days after hospital admission Commonly associated with Antibiotic-sensitive bacteria: - H. influenzae, oxacillin-sensitive S. aureus, and S. pneumoniae No risk factors for infection due to potentially antibiotic-resistant bacteria: - Antibiotic treatment or prior health care facility exposure
American Thoracic Society
Late onset
Bacteraemia
Abdominal sepsis Intravenous cannula infection Infected emboli
Clinical features and investigation of patients with hospital-acquired pneumonia are very similar to CAP
Clinical Features include: Shortness of breath Cough + sputum Fever Chills + Rigors Pleuritic Chest pain Nausea and vomiting Others: Lost of appetite, Headache, Fatigue, myalgias, arthalgias, anorexia
Management
Adequate gram ve coverage is usually obtained with:
3rd generation cephalosporin (eg. Cefotaxime) + an aminoglycoside (eg. Gentamicin) or Meropenem or A monocyclic -lactam (eg. Aztreonam) + flucloxacillin
Aspiration pneumonia can be treated with coamoxiclav 1.2g 8 hourly + Metronidazole 500mg 8 hrly. Physiotherapy important in immobile & elderly.
Adequate O2 therapy, fluid support and monitoring
References:
American Thoracic Society Documents Guidelines for the Management of Adults with Hospital-acquired, Ventilatorassociated, and Healthcare-associated Pneumonia
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