HWN Suggests

ALiEMU Capsules Module 9: Hospital Acquired Pneumonia

All patients with suspected HAP should receive an antibiotic that covers Pseudomonas and MSSA, with additional/modified coverage for MRSA or other resistant Gram negative organisms depending on risk factors. 1 Antibiotic Is Good, But 2 Must Be Better? P. aeruginosa is associated with a high mortality rate and rapid disease progression. As such, every HAP treatment regimen should include pseudomonal coverage. However, monotherapy is appropriate for patients not considered high risk for death... Over-Diagnosing or Under-Treating: To Add or Not Add MRSA Coverage? MRSA pneumonia can be over-diagnosed if contamination cannot be distinguished from true infection. The Shorr score – an MRSA risk-stratification…

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 Hospital-Acquired Pneumonia (HAP)

A broad-spectrum antipseudomonal agent is the backbone of therapy. This is generally cefepime or piperacillin/tazobactam... Meropenem may occasionally be considered, if there is concern for an extended-spectrum beta-lactamase resistance organism (ESBLs).

 The Not-So-Sick Health-Care Associated Pneumonia Patient: New Treatment Strategy

When a patient hits your ED with symptoms consistent with pneumonia and meets criteria for HCAP, you most likely reach for vancomycin plus a broad-spectrum, anti-pseudomonal beta-lactam such as piperacillin/tazobactam. Perhaps you even add on a second gram-negative agent such as a fluoroquinolone or aminoglycoside... In an era where antimicrobial stewardship is becoming increasingly essential to prevent further development of drug resistance, do we need to be hitting all of these seemingly well HCAP patients with ‘gorillacillin?’ A new study in Clinical Infectious Diseases says maybe not.

Articles of Interest

Hospital Acquired Pneumonia (Adult) – Treatment

Hospital Acquired Pneumonia (HAP) = pneumonia acquired after >48 hours of hospitalization. Increased risk of: Staphylococcus aureus, Pseudomonas aeruginosa, enteric gram-negative bacilli.

Down-Titrating Antibiotics for HCAP

The HCAP population is profoundly heterogenous, where patients receiving home wound care are grouped with patients with recent hospitalization and receipt of IV antibiotics. It is clear, then, patients will suffer adverse effects and costs from overly-broad spectrum antibiotic coverage.

REBEL Cast Episode 29: IDSA Pneumonia Update

As mentioned in the podcast, many of us see patients who were recently admitted for unrelated issues who now return with pneumonias but are very well appearing and without significant comorbid conditions. Uniformly, admitting these patients and treating them with broad spectrum antibiotics never made sense. It will be interesting to see what subsequent IDSA recommendations are for the treatment of HCAP and how this affects our treatment decisions. For now, in well appearing patients who are otherwise healthy with unremarkable vital signs, we are recommending treating HCAP in the same way we treat community acquired pneumonia and ensuring close follow up and giving explicit return.