Hospital Acquired Pneumonia (HAP).DOCVIP

HOSPITAL- ACQUIRED PNEUMONIA (HAP) PROF. ADEL KHATTAB,MD,FCCP.PROFESSOR OF PULMONARY MEDICINEAIN SHAMS UNIVERSITY Definition This infection is with onset of 48-72 hours of hospitalization, development of a new or progressive infiltrate in CXR, fever, leukocytosis and purulent tracheobronchial secretions. This infection was neither present nor incubating at the time of hospitalization. This definition, however may exclude cases that occur in outpatient settings or after discharge from the hospital. HAP refers to pneumonia that occurs (48 hours after admission, which was not incubating at the time of admission. HAP is closely related share the same principles with Ventilator-associated pneumonia (VAP) Healthcare-associated Pneumonia (HCAP). VAP refers to pneumonia that arises more than 48–72 hours after endotracheal intubation. Classification of HAP Patients - Is pneumonia mild to moderate or severe? - Are specific host or therapeutic risk factors predisposing to specific pathogens persent ? - Is pneumonia early onset (within 4 days of admission) or late onset? Early-onset HAP VAP: Within the first 4 days of hospitalization. Late-onset HAP and VAP: 5 days or more of hospitalization ATS DEFINITION OF SEVERE HAP Admission of ICU. Resp. failure, defined as need for mechanical ventilation or the need for 35% oxygen to maintain an arterial oxygen saturation 90%. Rapid radiographic multilobar pneumonia, or cavitation of a lung infiltrate. Evidence of severe sepsis with hypotension and/or end-organ dysfunction : Shock (systolic BP 90mmHg or diastolic Bp 60 mmHg) Requirement for vasopressors for 4 h. Urine output 20mL/h or total urine output 80mL in 4 h(unless another explanation is available). Acute renal failure requiring dialysis. EPIDEMIOLOGY Incidence of HAP 2nd most common nosocomial infection Rate 5-15 cases/