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Nosocomial Pneumonia
Aka: Nosocomial Pneumonia, Hospital Acquired Pneumonia
- See Also
- Pneumonia
- Epidemiology
- Complicates up to 1% of hospitalizations
- Mortality: 30-50%
- Etiologies
- Aspiration following Cerebrovascular Accident (CVA)
- Streptococcus Pneumoniae
- Anaerobic Bacteria
- Mechanical Ventilation
- Coliform bacteria (Gram Negative Bacteria)
- Pseudomonas aeruginosa (most common)
- Staphylococcus aureus (consider MRSA)
- Organ Failure
- Coliform bacteria (Gram Negative Bacteria)
- Air Conditioner Contamination
- Legionella pneumonia
- Airway Obstruction
- Anaerobic Bacteria
- Corticosteroid use
- Yeast
- Pneumocystis carinii Pneumonia
- Neutropenia (<500 Neutrophils/mm3)
- Aspergillus
- Candidiasis
- Symptoms
- Fever
- Purulent Sputum
- Labs
- Complete Blood Count
- Leukocytosis
- Arterial Blood Gas
- Increased A-a Gradient
- Radiology: Chest XRay
- New or progressive lung infiltrate
- Management: Antibiotics
- Imipenem 0.5 g IV q6 hours
- Meropenem 1.0 g IV q8 hours
- Aminoglycoside Combinations (2-3 antibiotics)
- Antibiotic 1: Aminoglycoside Options
- Gentamicin
- Tobramycin 5 mg/kg IV q24 hours
- Antibiotic 2 Options
- Ceftazidime 2 g IV q8 hours
- Piperacillin 4 g IV q6 hours
- Ticarcillin 4 g IV q6 hours
- Antibiotic 3 (consider)
- Clindamycin 450-900 mg IV q8 hours
- Ciprofloxacin Combinations (2 antibiotics)
- Antibiotic 1
- Ciprofloxacin 400 mg IV q12 hours
- Antibiotic 2
- Ticarcillin-Clavulanate (Timentin) 3.1 grams IV q6h
- Piperacillin-Tazobactam (Zosyn) 3.375 g IV q6 hours
- Organisms requiring additional antibiotic coverage
- Methicillin Resistant Staphylococcus Aureus (MRSA)
- Vancomycin 1 gram IV q12 hours given over 1 hour
- Legionella pneumonia
- Azithromycin 500 mg IV q24 hours or
- Broad spectrum Fluoroquinolone
- Trovafloxacin 300 mg IV q24 hours
- Levofloxacin 500 mg IV q24 hours
- Fungal Organisms (e.g. Aspergillus)
- Amphotericin B
- References
- Gilbert (2001) Sanford Antimicrobial, p. 28
- Bowton (1999) Chest 115:28S-33S
- Cunha (2001) Med Clin North Am 85(1):79-114
- Kollef (1999) Clin Chest Med 20(3):653-70
- Weber (1999) Chest 115:34S-41S