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HAI Lower Respiratory Tract Infections - Coggle Diagram
HAI Lower Respiratory Tract Infections
Epidemiology
Healthcare associated pneumonia (HAP)
Causative organisms
Gram - bacteria
E. Coli
Klebsiella
Pseudomonas aeruginosa
Can be multidrug resistant
Staph. aureus
(inc. MRSA)
Anaerobes
Legionella pneumophila
Influenza virus
Respiratory syncytial virus
Risk factors
Depressed level of consciousness
Subsequent aspiration
Mechanical ventilation (even in surgery)
Endotracheal intubation
Advanced age >70
Chronic lung disease
Neurological disease
Nasogastric feeding
Immobility
Ventilator associated pneumonia (VAP)
Most common ICU-acquired infection
Risk factor
Tracheal intubation
15-20% of nosocomial infections
Pathogenesis
HAP
Aspiration of oropharyngeal secretions
Most common route
Colonisation of oropharynx with gram - bacteria after hospitalisation
Inhalation of droplets/aerosols
Contaminated respiratory therapy/anaesthesia equipment
Person-to-persion spread
VAP
Bacteria bypass normal host defence mechanisms
Aspiration of microorganisms that colonise oropharynx
Micro-aspiration almost universal in intubated patients
Treatment/Prevention
Empiric
Based on local hospital guidelines
Antimicrobials with gram - activity
E.g. Piptazobactam
Other agents depending on severity/bacteria/risk factors
E.g. MRSA, Vancomycin
Targeted
Based on microbiology results and clinical progress
Prevention
Infection prevention
Staff influenza vaccination
Avoid sedatives if possible
Safe critical care environment
Prevent colonization
Prevent aspiration
VAP care bundles
