Nosocomial pneumonia

Community-acquired pneumonia PO 750 mg/day for 5 days or 500 mgfor 7-14 days. Pneumonia, nosocomial PO, IV 750 mg q24h for 7-14 days. 

Klebsiella pneumoniae +++ Nosocomial infections, opportunistic pathogen chronic pulmonary disease, enteric pathogenicity, nasal mucosa atrophy and rhinoscleroma. 

Cefuroxime (35) is effective against community-acquired pneumonia in which ampicillin-resistant Haemophilus influence is the probable etiologic agent. Cefoxitin (23) is used to treat mixed aerobic—anaerobic infections including pelvic infections, intra-abdorninal infections, and nosocomial aspiration pneumonia. Cefonicid (31), because of its long half-life has been used in a once-a-day regimen to treat a variety of mild to moderate infections including community-acquired pneumonias, urinary tract infections, and infections of the skin and soft tissue (132,215). 

Nosocomial bacterial pneumonia developing in patients on mechanical ventilation... 

Community-acquired pneumonia Health care-associated, ventilator-asociated, or nosocomial pneumonia (Early onset no risk factors for MDR pathogens) Third-generation cephalosporin plus a macrolide or doxycycline Third-generation cephalosporin OR Fluoroquinolone OR Ampicillin-sulbactam OR Ertapenem... 

Health care-associated, ventilator-associated, or nosocomial pneumonia (Late onset and/or MDR pathogen risk factors) Antipseudomonal penicillin OR Antipseudomonal cephalosporin OR Antipseudomonal carbapenem plus Aminoglycoside OR Antipseudomonal fluoroquinolone plus Vancomycin or linezolid... 

Freeman, R. Gould, F. K. Sisson, P. R. Lightfoot, N. F. Strain differentiation of capsule type 23 penicillin-resistant Streptcoccus pneumoniae from nosocomial infections by pyrolysis mass spectrometry. Lett. Appl. Microbiol. 1991, 13, 28-31. 

The strongest predisposing factor for nosocomial pneumonia is mechanical ventilation. Risk is increased by prior antibiotic use, use of H2-receptor antagonists, and severe illness. 

The diagnosis of nosocomial pneumonia is usually established by presence of a new infiltrate on chest radiograph, fever, worsening respiratory status, and the appearance of thick, neutrophil-laden respiratory secretions. 

Nosocomial pneumonia Gram-negative bacilli (such as K pneumoniae, Enterobacter spp.. Pseudomonas aeruginosa), 5. aureus Pi peraci 11 i n-tazo bacta rr carbapenem,e or extended-speclrum cephalosporin plus aminoglycoside, fluoroquinolone ... 

With nosocomial pneumonia, the above parameters should be assessed along with white blood cell counts, chest radiograph, and blood gas determinations. 

The urinary pathogens in complicated or nosocomial infections may include E. coli, which accounts for less than 50% of these infections, Proteus spp., Klebsiella pneumoniae, Enterobacter spp., Pseudomonas aeruginosa, staphylococci, and enterococci. Candida spp. have become common causes of urinary infection in the critically ill and chronically catheterized patient. 

Doripenem Carbepenem 2007 2008 Launched Nosocomial infections caused by S. aureus, P. aeruginosa, S. pneumoniae... 

Ceftobiprole Cephalosporin 2008 2009 2010 Nosocomial pneumonia and cSSSIs caused by MRSA... 

Centers for Disease Control and Prevention., Guideline for prevention of nosocomial pneumonia,... 

Tod, M., Minozzi, C., Beaucaire, G., Ponsonnet, D., Gougnard, J., and Petitjean, O., Isepamicin in intensive care unit patients with nosocomial pneumonia population pharmacokinetic-pharmacodynamic study, /. Antimicrob. Chemother., 44, 99-108,1999. 

Serious infections Septicemia, nosocomial pneumonia, intra-abdominal infections, aerobic and anaerobic gynecologic infections, and skin and soft tissue infections ... 

Nosocomial pneumonia - Start with 3.375 g every 4 hours plus an aminoglycoside. Continue the aminoglycoside in patients from whom Pseudomonas aeruginosa is isolated. 

Nosocomial pneumonia mild/moderate/severe 400 mg IV q 8 h 1200 mg IV lOto 14 days... 

Pneumonia - Do not use oral azithromycin in patients with pneumonia who are judged to be inappropriate for oral therapy because of moderate to severe illness or risk factors such as any of the following nosocomially acquired infections known or suspected bacteremia conditions requiring hospitalization cystic fibrosis significant underlying health problems that may compromise patients ability to respond to their illness (including immunodeficiency or functional asplenia) elderly or debilitated patients. 

Nosocomial pneumonia For the treatment of nosocomial pneumonia caused by S. aureus (methicillin-susceptible and -resistant strains), orS. pneumoniae (penicillin-susceptible strains only). 

Levofloxacin (1), the levo-isomer or the (5)-enantiomer of ofloxacin, received FDA approval in 1996 (Fish, 2003 Hurst et al., 2002 Mascaretti, 2003 Norrby, 1999 North et al., 1998). The initial approval covered community-acquired pneumonia, acute bacterial exacerbation of chronic bronchitis, acute maxillary sinusitis, uncomplicated skin and skin structure infections, acute pyelonephritis, and complicated urinary tract infections (North et al., 1998). Four years later, the levofloxacin indication list grew to include community-acquired pneumonia caused by penicillin-resistant Streptococcus pneumoniae. In addition, in 2002, nosocomial (hospital-acquired) pneumonia caused by methicillin-susceptible Staphylococcus aureus, Pseudomonas aeruginosa, Serratia marcescens, Haemophilus influenzae, Kliebsella pneumoniae, and Escherichia coli was added (Hurst et al., 2002). Finally in 2004, LVX was approved as a post-exposure treatment for individuals exposed to Bacillus anthracis, the microbe that causes anthrax, via inhalation (FDA, 2004). 

The spectrum of respiratory tract infections (RTI) can vary from the common cold to acute or chronic bronchitis to community-acquired pneumonia to nosocomial pneumonia and aspiration pneumonia to ventilator-associated pneumonia to chronic pneumonia (in cystic fibrosis, histoplasmosis, tuberculosis, etc.). Important complications are lung abscess and pleural empyema that will often need drainage and prolonged antimicrobial treatment (>6 weeks). 

The majority of sepsis cases, especially the more severe forms, have bacterial etiologies. Common bacterial species include Staphylococcus aureus. Streptococcus pneumoniae, Escherichia coli. Salmonella typhi (and other enterobacterial species). Pseudomonas species and haemolytic streptococci in children Haemophilus influenzae and Neisseria meningitidis are important whereas nosocomial episodes of sepsis are frequently caused by Staphylococcus epidermidis. Streptococcus faecalis (syn. enterococci), yeasts and anaerobes. 

Lower respiratory tract infections IV 400 mg ql2h for 7-14 days. PO 500mgql2hfor 7-14 days (750 mgql2h for 7-14 days for severe or complicated infections). Nosocomial pneumonia IV 400 mg q8h for 10-14 days. 

Prophylaxis of stress ulceration in intensive care units is the major interest to the anaesthetist. Here, it is given in a dose of 1 g every 6 hours via nasogastric tube. Several studies have shown sucralfate to be comparable in efficacy to H2 blockers. It has been claimed, but not proved, to result in a reduction in morbidity and mortality from nosocomial pneumonias in comparison to H2 antagonists. The latter, by raising gastric pH, eliminate the acid barrier to colonisation of the gut by pathogens, which sucralfate does not do. 

Linezolid s a novel oxazolidinone antibiotic with exclusively Gram-positive activity (including MRSA) which acts at the level of the 30S and 70S ribosomal subunits by a unique mechanism it inhibits protein synthesis by preventing formation of initiation complexes. Linezolid has excellent oral bioavailability and tissue penetration the most important adverse effect is marrow suppression which is usually reversible. Its major indications are soft tissue infections and nosocomial pneumonia, although these will probably expand in the future. 

Selective decontamination of the gastrointestinal tract was conceptualised with a view to preventing nosocomial infection (mainly due to enterobacteriaciae), specifically ventilator-associated pneumonia, in intensive care units. Protocols typically included the prescription of an intravenous cephalosporin with good activity against such Gram-negative pathogens (e.g. cefotaxime) with co-prescribed, poorly... 

H2 antagonists are extremely safe drugs. Adverse effects occur in less than 3% of patients and include diarrhea, headache, fatigue, myalgias, and constipation. Some studies suggest that intravenous H2 antagonists (or proton pump inhibitors) may increase the risk of nosocomial pneumonia in critically ill patients. 

Gastric acid is an important barrier to colonization and infection of the stomach and intestine from ingested bacteria. Increases in gastric bacterial concentrations are detected in patients taking proton pump inhibitors, which is of unknown clinical significance. Some studies have reported an increased risk of both community-acquired respiratory infections and nosocomial pneumonia among patients taking proton pump inhibitors. 

---