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- Nosocomial pneumonia (NP)- pneumonia occuring after 7 days of hospitalization; early nosocomial pneumonia occurs 5 days post-hospitalization and is considered an incubating community-acquired pneumonia.
- Third most common nosocomial infection on surgical services after urinary tract and wound infections but is associated with slightly higher mortality
- Risk factors: atelectasis and ICU care (22% of ICU patients develop a pneumonia); endotracheal intubation (3 days of intubation = 8% risk, 7 days of intubation = 21% risk and 45% for those intubated more than 14 days)
- Causative organisms are predominantly Gram negative aerobic including pseudomonas aeruginosa, proteus mirabilis, serratia marcescens, E. Coli, Klebsiella, and Enterobacter.
- staph and strep are the cause in only 14% of cases
- anaerobic organisms are found in only 2% of cases but are more likely in aspiration pneumonias
- Etiology for early NP (Streptococcus pneumoniae, haemophilus influenzae, Moraxella catarrhalis, and atypical pathogens)
- NP: cefepime OR meropenem PLUS levofloxacin, or aztreonam, or amikacin, or piperacillin
- Early NP: macrolides, fluoroquinolones, doxycycline, cephalosporines