3. Treatment of hospital acquired pneumonias

Definition

• Pneumonia that occurs 48 hours or more after hospital admission and is not present at the admission time.

Etiology

• Aerobic gram - bacilli (P.aeuroginosa, E.coli, K.pneumoniae, enterobacter species)
• Gram positive cocci (Staphylococci, Streptococci)

Pathogenesis

• The pathogenesis of HAP involves several factors:
• Vulnerability- hospitalized patients may have compromised immune systems or other health conditions that make them susceptible to infections
• Aspiration- patients protective mechanisms (like gag reflex) can be impaired due to intubation, sedation etc which can pose risk for gastric content aspiration
• Contaminated equipment and surfaces- can serve as sources of infection
• Length of hospitalisation- longer a person stays at hospital, their risk of acquiring HAP is increased

Symptoms

• Cough
• Expectoration
• Rise in body temperature
• Chest pain
• Dyspnea
• Confusion or altered mental status
• Chills
• Sweating
• Headache
• Muscle aches

Physical exam

Inspection

• Cyanosis of lips or nail beds
• Increased respiratory rate (tachypnea)
• Visible distress
• Fever

Percussion

• Dullness may be heard in affected regions

Auscultation

• Weak vesicular breathing
• Crackles
• Wheezing may be heard