Nosocomial pneumonia or Hospital-acquired pneumonia (HAP) is pneumonia contracted by a patient in a hospital at least 2 days or more after admission.
HAP is the most common cause of death among nosocomial infections and it is the 2nd most prevalent nosocomial infection after UTIs.
Most of them are caused by gram-negative bacilli
About 19% of cases of HAP are caused by Staphylococcus aureus, majority of which are of the MRSA type.
A small proportion of HAPs are caused by viruses that such as influenza virus, respiratory syncytial virus, and cytomegalovirus (especially in immunocompromised host).
##The common sources / types of nosocomial infections are:
IV devices that are exposed to contamination with staphylococci and other Gram-positive bacteria
Wounds from indwelling urinary catheters that are likely to be infected with Gram-negative bacteria
Wounds from tracheostomy and ventilators that are likely to be infected with the mixed bacterial flora
Post-surgical wounds that are also likely to be infected with various bacteria.
Shortness of breath
Cough with sputum that may be rust-coloured.
Cough without sputum
Fever (≥ 38 deg C)
Chest pain (mainly pleuritic)
Reduced chest movement
Tachypnoea (respiratory rate or the breathing per minutes cut-offs for various ages are as follows: 0-2 months old ≤ 60, 2-12 months old ≤ 50, 12-60 months old ≤ 40 and adults and children above 5yrs ≤ 30
Indrawing of chest (in severe cases)
Cyanosis (in severe cases)
Confusion and/or disorientation
Newly developed infiltrate on the chest X-Ray
Complete Blood Count
Chest X-ray to check for severe pneumonia, complications of pneumonia, TB and cardiac disease.
Lumber puncture & culture
It is advisable to test for HIV in order to modify and maximize the management
Decrease aspiration by the patient
Preventing cross-contamination from hands of personnel
Appropriate disinfection or sterilization or respiratory therapy devices
Vaccines to protect against particular infections
Education of hospital staff and patients.
##Use combination of antibiotics with activities against Gram +ve and Gram -ve bacteria:
IV/IM Cloxacillin PLUS IV/IM gentamicin
IM/IV Ceftazidime PLUS EITHER IM/IV gentamicin OR IV Ciprofloxacin
##In case methicillin-resistant Staphylococcus aureus (MRSA)
Add IV Vancomycin to the above regime
IV Imipenem + Cilastatin (reserve drug)
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