Hospital Acquired Pneumonia

Definition:

The Hospital acquired pneumonia (HAP) or nosocomial pneumonia is said to be any pneumonia that can occur to the patient in a hospital at least 48–72 hours after admission.
It is usually caused by a bacterial infection, instead of a viral infection.
HAP is the second most common nosocomial infection (urinary tract infection is the most common) and accounts for 15–20% of the total.
HAP typically lengthens a hospital stay by 1–2 weeks.

Sign & symptoms:

Fever > 37.8 °C (100 °F).
Sputum Purulent.
Leucocytosis > 10.000 cells/μl.

Types:

Bacterial pneumonia;
The majority of cases related to various gram-negative bacilli and S.aureus,.
Usually of the MRSA type.
Others are Haemophilus spp.
In the ICU results were S.aureus(17.4%).
P.aeruginosa (17.4%).
Klebsiella pneumoniae.
Enterobacter spp. (18.1%),.
Haemophilus influenzae (4.9%).[1]
Viral pneumonia;
influenza and respiratory syncytial virus.
In the immunocompromised host, cytomegalovirus- cause 10-20% of infections

Diagnosis:
In respiratory insufficiency; chest X-Ray (CXR).
Increasing leucocyte count.
In case of pleural effusion thoracentesis; is performed for examination of pleural fluid.



Management:
Usually initial therapy is empirical.
If sufficient reason to suspect influenza, one might consider oseltamivir.
In case of legionellosis, erythromycin or fluoroquinolone.
A third generation cephalosporin (ceftazidime)
+
carbapenems (imipenem)
+
beta lactam
&
beta lactamase inhibitors (piperacillin/tazobactam).