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Hospital Acquired Pneumonia- Definition, Predisposing Factors, Clinical Features and Management!

 HOSPITAL ACQUIRED PNEUMONIA

Definition:

"HAP refers to a new episode of pneumonia occurring at least 2 days after the administration to hospital. It is the most common Hospital Acquired Infection (HAI) and leading cause of HAI-associated death".



Predisposing factors:

  1. Aspiration of nasopharyngeal secretion
  2. Bacteria introduced into the lower GIT.
  3. Bacteriaemia
  4. Old age


Mode of Spread:

  •  Droplet infection


Infecting agent:

Bacteria: S.pneumonia , S.aureus , H.influenza

Virus: Adenovirus, Corona virus, Herpes Simplex


Clinical Features:

  • Purulent sputum
  • New radiological infiltrates
  • Temperature > 38 degree Celsius
  • Leukocytosis


Investigations:

  1. Chest Pain: to confirm the diagnosis and exclude complication.
  2. Pulse Oximetry: to monitor response to oxygen therapy, if SaO2 < 93% features of sever pneumonia, identify ventilatory failure or acidosis.
  3. Cell count: ESR, Neutrophil leukocytosis
  4. Microbiological studies: for severe CAP and those that do not respond to initial therapy (Gram stain, sputum culture, blood culture)
  5. Renal Function test: Urea and Electrolytes
  6. Liver Function test: Elevated C-Reactive protein
  7. Complete Blood Count (CBC)
  8. Chest X-Ray

Management:

The goal for management involves:
  • Oxygen therapy
  • Fluid balance
  • Antibiotic therapy
  • In severe illness--Nutrition support


1. Oxygen Therapy:
  • Oxygen should be administered to all the patients with tachypnea, hypoxemia, hypotension with the aim of maintaining SaO2 at >92%.
  • Indicated for: Referral to Intensive Therapy Unit (ITU) including.
  1. Persistent hypoxia SaO2 <90% despite high concentration of O2.
  2. Severe acidosis
  3. Circulatory shock
  4. Reduced conscious level.

2. IV Fluids:
  • should be considered in patients with severe illness, older patients, those who are vomiting. Oral fluid intake is encouraged.

3.Antibiotics:

  • Patients who have not received antibiotics previously can be treated with Co-Amoxiclav.
  • If patients have received course of recent antibiotic, then Piperacillin/Tazobactam/Cephalosporin
  • If patients have late onset of HAP, choice of antibiotics must cover Gram Negative S.aureus and anaerobes.
  • Anti-pseudomonal cover is provided by Carbapenem or 3rd Generation Cephalosporin and Aminoglycosides
  • MRSA cover provided by glycopeptides such as Vancomycin.



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