AppropriateAntibioticsuseinCAPandHCAPatSisters.ppt

Appropriate Antibiotics use in CAP and HCAP at Sisters Hospital in 2008. Syed Faraz Masood, MBBS Nashat H. Rabadi, MD, FCCP Community Acquired Pneumonia Common : 5 to 6 million cases/year 20% are hospitalized 10% in ICU No. 1 cause of death from infectious disease No. 6 cause of death in adults Mortality rates : Outpatients 1-5% Inpatients 12% higher in ICU- 50% Costs : 9.7 billion : inpatient – $7,517 vs. outpatient - $264 CAPDefinition CXR – infiltrate Auscultatory findings Signs of RTI Cough +/- sputum Fever or hypothermia WBC CAP - Pathogenesis Aspiration Inhalation Hematogenous Direct extension Reactivation Risk Factors. Age. Smoking. Co-morbid Conditions. Poor Prognosis. Pleural Effusion. Bacteremia. Cultures. Sputum Cx Not needed as outpatient. May or may not be needed inpatient. Blood Cx Urinary Antigens. CURB - 65 Management. Site of Care: Inpatient vs. outpatient. Floor vs. ICU. PSI CURB 65 Empirical Treatment Hospitalized Patients: 2nd or 3rd generation Cephalosporins plus a Macrolide. Floroquinolones. For all critically ill patients, 2nd or 3rd generation Cephalosporin + Macrolide or Floroquinolones – necessary to provide coverage for Legionella Pneumophilia. Change antibiotics – based on culture and sensitivity. Nosocomial Pneumonia Hospital Acquired Pneumonia: 48 hours of admission to hospital. Ventilator associated Pneumonia. 48 hours of intubation. Health-care Associated Pneumonia. Antimicrobial therapy in preceding 90 days. Hospitalization for 2 or more days in the preceding 90 days. Residence in a NH or an extended care facility. Home infusion therapy. Chronic Dialysis within 30 days. Immunosuppressive state and/or therapy. Health-care Associated Pneumonia. Epidemiology extrapolated from HAP/VAP Second most common Nosocomial Infection. High morbidity / mortality. Increase hospital stay by 7-9 days. Excess cost of $ 40,000 per patient. Early VAP/HAP 5 days Similarly as CAP No MDR pathogens. Late VAP/HAP 5 days