hap/vap

pneumonia not incubating at the time of hospital admission; must be hospitalized for > 48 hours

hospital acquired pneumonia (HAP)

pneumonia occurring > 48 hours after intubation

ventilator associated pneumonia (VAP)

prevention for VAP

elevate head of bed

avoid intubation/extubate asap

minimize sedation

chorhexidine swabs

respiratory secretion cultures should be collected for which population?

VAP

you can do HAP when possible but not required

preferred culture for VAP

bronchoscopy with quantitative culture

what value indicates withholding antibitoics?

< 10^4 CFU

blood cultures should be collected for which population?

HAP and VAP

common pathogens for HAP/VAP

"PEAS and V"

P. aeruginosa

Enterobacterales (E. coli and K. pneumonia)

Acinetobacter spp

S. aureus (MRSA)

Viruses

Not at high risk of mortality / no risk factors for MRSA

antipseudomonal agent

Not at high risk of mortality / with risk factors for MRSA

antipseudomonal agent

anti-MRSA agent

High risk of mortality or risk factors for multi-drug resistant HAP

two antipseudomonal agents

anti-MRSA agent

what does high risk of mortality mean in HAP

need for ventilatory support

when should we have MRSA coverage

Coverage should be provided if hospital has > 10-20% rate of MRSA

or

If prevalence is unknown

when should we provide two antipseudomonal agents

if > 10% of gram negative isolates are resistant to the agent being considered for monotherapy

or

local antibiogram is not available

what are the anti-MRSA agents

vancomycin and linezolid

what are the antipseudomonal agents

pip/tazo

cefepime and ceftazidime

meropenem, imipenem, and aztreonam

cipro and levo

treatment duration for HAP/VAP

7-8 days

toxicities of aminoglycosides

nephrotoxicity and ototoxicity

toxicities of IV vancomycin

nephrotoxicity and vancomcin infusion reaction

toxicities of linezolid

thrombocytopenia, myelosuppression, and serotonin syndrome when given with MAOIs