-
Risk factors for MDR HAP
- prior IV abx use in past 90d
-
Common early HAP pathogens
- S. pneumoniae
- MSSA
- H. influenza
- KEEPS
-
Empiric HAP tx w/o MRSA risk
- cefepime
- Zosyn
- levofloxacin
-
Empiric HAP tx w/ MRSA risk
- Zosyn
- cefepime
- levo or cipro
PLUS vanco or linezolid
-
Empiric HAP tx w high risk of mortality/IV abx in past 90d
- 2:
- - Zosyn
- - cefepime, ceftazidime
- - levo, cipro
- - imipenem, mero
- - AG
- - aztreonam
PLUS vanco or linezolid
-
duration of HAP tx
7 days
-
Common late HAP pathogens
- same as early PLUS
- MRSA
- Pseudomonas
- Acinetobacter
- Enterobacter
-
Common CAP pathogens
- S. pneumoniae
- H. influenza
- M. cataralis
-
CAP risk factors/comorbidities for DR S. pneumoniae
- abx use in past 3mos
- HF
- DM
- cancer
- renal/liver dysfcn
- alcoholism
- malignancies
- asplenia
- immunosuppression
-
CAP outpt tx w/o risk factors/comorbidities
-
CAP outpt tx w/ S. pneumoniae risk
- respiratory quinolone (GLM)
- beta-lactam plus macrolide or doxy
-
Inpt CAP tx (non-ICU)
- beta-lactam plus macrolide or doxy
- resp quinolone
-
Inpt CAP tx (ICU)
- IV tx req'd
- beta-lactam plus azithro or FQ
-
anti-Pseudomonal abx
- Zosyn (pip/tazo)
- cefepime
- imipenem, meropenem, doripenem
- AG
- levo, cipro
- polymyxin
- fosfomycin
-
Inpt CAP Pseudomonal tx
- Zosyn
- cefepime
- imipenem, meropenem
-
Duration of CAP tx
- min 5 days
- must be afebrile for 48-72h
- no more than 1 CAP-associated sign of clinical instability
-
Criteria for severe CAP
- RR >30 breaths/min
- multilobar infiltrates
- confusion
- uremia (BUN >20mg/dl)
- Leukopenia (WBC <4000)
- Thrombocytopenia (plt <100,000)
- Hypothermia (<36C)
- Hypotension requiring fluid resuscitation
- Mechanical ventilation
- Septic shock
-
Criteria for clinical stability (6)
- T <37.8 C
- HR <100 bpm
- RR <24
- SBP >90 mmHg
- art O2 sat >90% or pO2 >60
- ability to maintain oral intake
- normal mental status
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