Pneumonia is defined as an acute infection of the lung parenchyma. It is the most common cause of death in industrialized countries.
Hospital-Acquired Pneumonia (HAP) is a new episode of pneumonia that occurs at least two days after admission to the hospital
Those at risk-
- Elderly
- Those in ICU, especially if mechanically ventilated
- Reduced clearance mechanisms
- Reduced consciousness
- Vomiting, dysphagia
- Nasogastric intubation
- Dental or sinus infection
- Abdominal sepsis
- IV cannula infection
Clinical features
- Purulent sputum
- New radiological infiltrates
- Increase in oxygen requirements
- Fever >38.3oC
Investigations
- CBC- low or high WBC
- Chest Xray
- Sputum, or Broncho alveolar lavage aspirates for analysis
*Microbiological confirmation must be done
- PE
- ARDS
- Pulmonary oedema
- Drug toxicity
- Pulmonary haemorrhage
Management
1. Early-onset HAP- within 4 to 5 days of admission. Organisms are similar to those of community-acquired pneumonia
- Cefuroxime or co-amoxiclav if the patient has not received any antibiotics
- Piperacillin/tazobactam or 3rd generation cephalosporin if they have received antibiotics
2. Late-onset HAP- mainly caused by gram negatives- E.coli, Pseudomonas, Klebsiella, S.aureus including MRSA
- Carbapenem, antipseudomonal cephalosporin or piperacillin-tazobactam for Pseudomonas
- Vancomycin or linezolid for MRSA
*Duration depends on clinical judgement
Prevention
- Good hygiene
- Steps to minimize aspiration and limit the use of PPIs
- Oral antiseptic to decontaminate the upper airway
- Decontamination of the digestive tract in some centres
