pneumonia%20-%20hospital-acquired
PNEUMONIA - HOSPITAL-ACQUIRED
Hospital-acquired pneumonia (HAP) is defined as pneumonia occurring ≥48 hours after admission and excluding any infection that is incubating at the time of admission.
Ventilator-associated pneumonia (VAP) is described as pneumonia occurring >48-72 hours after endotracheal intubation and within 48 hours after removal of endotracheal tube.
Early-onset HAP or VAP is the pneumonia occurring within the first 4 days of hospitalization that may be cause by antibiotic-sensitive bacteria that usually carries a better diagnosis.
Late-onset HAP or VAP is the pneumonia occurring after ≥5 days. It is likely caused by multidrug-resistant pathogens associated with increased mortality and morbidity.

Pneumonia%20-%20hospital-acquired Signs and Symptoms

Definition

Hospital-acquired Pneumonia (HAP)
  • Defined as pneumonia occurring ≥48 hours after admission and excluding any infection that is incubating at the time of admission
Ventilator-associated Pneumonia (VAP)
  • Described as pneumonia occurring >48-72 hours after endotracheal intubation and within 48 hours after removal of endotracheal (ET) tube

Signs and Symptoms

Typical Signs and Symptoms
  • Fever
  • Cough with or without sputum production
  • Purulent sputum
  • Dyspnea, shortness of breath (SOB)
  • Respiratory failure
Other Findings
  • Worsening oxygenation
  • Increased heart rate
  • Increased minute ventilation

Risk Factors

Risk Factors for Hospital-acquired Pneumonia/Ventilator-Acquired Pneumonia
  • Patient-related: Age, chronic pulmonary disease, multiple organ system failure, depressed consciousness
  • Treatment-related: Intubation/mechanical ventilation, reintubation, prolonged intubation, previous exposure to antibiotics, thoracoabdominal surgery
  • Triggers of aspiration: Positioning, nasogastric tube insertion, enteral feeding, low ET tube pressure
  • Oropharyngeal colonization
Risk Factors for Hospital-acquired Pneumonia/Ventilator-Acquired Pneumonia
  • ≥5 days duration stay for the current hospitalization prior to occurrence of VAP
  • Septic shock at the time of VAP
  • Acute respiratory distress syndrome preceding VAP
  • Acute renal replacement therapy before VAP onset
  • IV antibiotics within the preceding 90 days
    • Risk factor for MDR, MRSA, and MDR Pseudomonas VAP and HAP
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