Nosocomial pneumonia

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  1. 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.
  2. Third most common nosocomial infection on surgical services after urinary tract and wound infections but is associated with slightly higher mortality
  3. 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)
  4. Causative organisms are predominantly Gram negative aerobic including pseudomonas aeruginosa, proteus mirabilis, serratia marcescens, E. Coli, Klebsiella, and Enterobacter.
    1. staph and strep are the cause in only 14% of cases
    2. anaerobic organisms are found in only 2% of cases but are more likely in aspiration pneumonias
    3. Etiology for early NP (Streptococcus pneumoniae, haemophilus influenzae, Moraxella catarrhalis, and atypical pathogens)
  5. treatment:
    1. NP: cefepime OR meropenem PLUS levofloxacin, or aztreonam, or amikacin, or piperacillin
    2. Early NP: macrolides, fluoroquinolones, doxycycline, cephalosporines
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