Case # 31

M.C., a 60y/o male, has already been experiencing nausea,

vomiting & diarrhea aside from having developed PNEUMONIA while in the hospital. Lab exams

and his other manifestations revealed that the patient is already

suffering from SEPSIS.

“Pneumonia while in the hospital”

Dx: Hospital Acquired Pneumonia (HAP) NOSOCOMIAL INFECTION, an

infection that was not found present prior to hospital admission (w/in 48 hrs.)

Specific type: 64% isolated from the lung of the pt were GRAM (+) cocci

S. Aureas BUT

My suspect: GRAM (-) bacilliMy suspect: GRAM (-) bacilli

P. AeroginosaP. Aeroginosa

MOT: Contact, Airborne, Vehicle and or Vector

(prevention UNIVERSAL PRECAUTION)

CDC staff handwash enough?

NICU 29%

ICU 81%

WARD 16%

Think? INSIDE THE BOX OUTSIDE THE BOX

Possible due to? NOT IN OUR HISTORY

Dx: Pneumonia (but hospital acquired type in Hx)

Gram(-) GIT

?Endotracheal Intubation, nasogastric tubing or enteral feeding ASPIRATION P.:Indwelling catheter

Gram(+) nose,Skin

?Bacteria,Viral,Fungi COMMUNITY ACQUIRED P.

Other organism 21%P.Aeroginosa,9%Enterobacter or 8%K.Pneumonia

DIAGNOSTIC ACCURACY

“controversial” bec. We have to be certain what organism or PNEUMONIA is really

present.

LAB Dx: endotracheal aspiration, FOB fiberoptic bronchoscope, gram staining,

BBS blinded bronchial sampling. Sensitivity of this test ave. 95%

Empirical Antibiotic Tx for HAP

• Have to understand the local patterns of anti-bacterial resistance.

• If MRSA prevalent in the institution, Vancomycin should be included can also use Quinupristin-dalfopristin and linezolid.

• KEY “broaden the spectrum of antibacterial treatment and continued lab testing”

• DOC P.Aeruginosa =

Carbencillin + Aminoglycoside

STOP! DO NOT FORGET!

• SEPSIS most often complication of HAP, so follow regimen for proper medication administration.

• Electrolyte imbalance due to vomitting and diarrhea.

t.y.

• Pulmonary Infections• Occurs in:• a. Loss or suppression of cough

reflex• b. Injury to the mucocilliary

apparatus• c. Interference with the phagocytic or

bacterial action of alveolar macrophages

• d. Pulmonary congestion and edema• e. Accumulation of secretion