Hospital-Related Pneumonia

Hospital-related pneumonia (HCAP) occurs in non-hospitalized patients who live in a nursing home, or other long-term care facility; who underwent i.v. therapy (including chemotherapy) or wound care within the past 30 days; who had been admitted to an acute care hospital for ? 2 days within the last 90 days; or who visited a hospital or a hemodialysis center within the last 30 days. In addition to the usual community-acquired pathogens (Community-acquired pneumonia: etiology) include HCAP pathogens gram-negative bacteria (including Pseudomonas aeruginosa) and Staphylococcus aureus (including methicillin-resistant S. aureus) and various antibiotic-resistant pathogens with one. The symptoms similar to pneumonia with other origin except for the fact that many older patients have less significant changes in their vital signs. The diagnosis is made due to the clinical picture and chest x-ray image. Treatment is carried out with broad-spectrum antibiotics, the mortality rate is excessively high, but can be partially attributed to existing comorbidities.

The definition of HCAP was established to develop patients who have an increased risk of pneumonia by antibiotic-resistant organisms to identify and therefore require a broad-spectrum antibiotic therapy. (Overview of pneumonia (pneumonia)). An acquired in nursing homes pneumonia is the most common subgroup of HCAP. Risk factors are frequently debilitated nursing home residents; they include

Hospital-related pneumonia (HCAP) occurs in non-hospitalized patients who live in a nursing home, or other long-term care facility; who underwent i.v. therapy (including chemotherapy) or wound care within the past 30 days; who had been admitted to an acute care hospital for ? 2 days within the last 90 days; or who visited a hospital or a hemodialysis center within the last 30 days. In addition to the usual community-acquired pathogens (Community-acquired pneumonia: etiology) include HCAP pathogens gram-negative bacteria (including Pseudomonas aeruginosa) and Staphylococcus aureus (including methicillin-resistant S. aureus) and various antibiotic-resistant pathogens with one. The symptoms similar to pneumonia with other origin except for the fact that many older patients have less significant changes in their vital signs. The diagnosis is made due to the clinical picture and chest x-ray image. Treatment is carried out with broad-spectrum antibiotics, the mortality rate is excessively high, but can be partially attributed to existing comorbidities. The definition of HCAP was established to develop patients who have an increased risk of pneumonia by antibiotic-resistant organisms to identify and therefore require a broad-spectrum antibiotic therapy. (Overview of pneumonia (pneumonia)). An acquired in nursing homes pneumonia is the most common subgroup of HCAP. Risk factors are frequently debilitated nursing home residents; They include Worse functional status Affective disorder of consciousness swallowing immunosuppression Seniority use of tube feeding influenza or other viral respiratory infections and conditions that are predisposed to bacteremia (z. B. Duration urinary catheter, bedsores) outpatient presence of a tracheostomy tube pathogens addition to the usual adventitious agents (acquired Outpatient pneumonia: etiology) include HCAP pathogens gram-negative bacteria (including P. aeruginosa) and Staphylococcus aureus (including methicillin-resistant S. aureus) and various antibiotic-resistant pathogens a. The most common pathogens are Streptococcus pneumoniae Gram-negative rods These organisms can for example be in charge the same number of infections; it is not clear whether gram-negative bacteria are sometimes more populated bacteria as causative pathogen. Haemophilus influenzae and Moraxella catarrhalis are the next most frequent pathogens. Chlamydia, Mycoplasma and Legionella spp. are rarely identified as triggers. Polymicrobial infections and infections with antibiotic-resistant organisms, particularly methicillin-resistant S. aureus and Pseudomonas infection are much more likely with antibiotics at a prior treatment (within the last 90 days). Infection with a resistant microorganism worsen mortality and morbidity significantly. As with other risk factors for polymicrobial infection and antibiotic-resistant organisms are Aktuellre hospitalized for ? 5 days High incidence of antibiotic resistance in society, in the hospital, or special Krankenhausabreilung hospitalization for ? 2 days within the last 90 days stay in a nursing home or care facility Outpatient infusion therapy (including antibiotics) dialysis treatment wound care family member with an infection due to antibiotic-resistant pathogen immunosuppressive disease or therapy because of these factors, however, may increase the risk of polymicrobial and antibiotic-resistant organisms are overestimated and lead to excessive use of broad-spectrum antibiotics. Symptoms and discomfort symptoms often resemble those of community-acquired or hospital-acquired pneumonia, but may be more subtle. Cough and decreased consciousness are common, such as non-specific symptoms of anorexia, weakness, restlessness and excitement, falling, and incontinence. Subjective dyspnea occurs, but is rare. Among the study findings include reduced or absent responses in response, fever, tachycardia, tachypnea, sputum production, wheezing or wet RG and wheezing and spitting breathing. Diagnosis Clinical manifestations chest x-ray assessment of renal function and oxygenation Diagnosis is based on clinical manifestations (eg. As fever, cough, sputum) and a chest x-ray with infiltrate. Blood tests can show leukocytosis. Since changes in physical status could be detected in nursing homes delayed and because these patients have a higher risk of complications, a study on hypoxemia by pulse oximetry and dehydration by determination of serum urea and creatinine should be performed. X-rays are usually difficult to perform in patients in nursing homes, so the patients must be hospitalized at least for the initial diagnosis. In some cases (eg. As when the clinical diagnosis is clear, if the disease is mild, or if aggressive care is not the goal), the treatment without confirmation to start by radiography. It is believed that patients from nursing homes to start missing radiographically detectable infiltrates, presumably because of the dehydration that usually accompanied a feverish pneumonia in elderly patients or because of an impaired immune defense. Clinical calculator: community-acquired pneumonia Severity Index (PSI) in adults Prognosis The mortality rate in hospitalized patients in the hospital is 13-41%, wherein the rate is in treated patients in nursing home 7-19%. Treatment Antibiotics Few data are available to guide decisions about where the treatment will take place. In general, patients should be hospitalized if they have ? 2 unstable vital signs and if the nursing home can not perform acute care. Some patients in nursing homes are under no circumstances candidates for aggressive treatment or hospital transfers. In patients who are hospitalized, should a dose of an antibiotic against S. pneumoniae, H. influenzae acts, and frequently occurring gram-negative rods are placed prior to transport. A common regulation scheme is an oral anti-pneumococcal quinolone (z. B. levofloxacin 750 mg of 1-times daily or 400 mg Moxifloxacin 1 time daily). Ceftriaxone, ertapenem and ampicillin / sulbactam (both as monotherapy) are alternatives. Key points The hospital-acquired pneumonia (HCAP) occurs in non-hospitalized patients who have had recent contact with the health system, including nursing homes, dialysis centers and infusion centers. The causative agent profile of the hospital-related pneumonia is different from the community-acquired pneumonia and requires a broader empirical antibiotic therapy, which is active against antibiotic-resistant organisms.

Health Life Media Team

Leave a Reply