Download Case # 31 MC, a 60y/o male, has already been

Case # 31
M.C., a 60y/o male, has already
been experiencing nausea,
vomiting & diarrhea aside from
having developed PNEUMONIA
while in the hospital. Lab exams
and his other manifestations
revealed that the patient is already
suffering from SEPSIS.
Think?
INSIDE THE BOX
“Pneumonia while in the hospital”
Dx: Hospital Acquired Pneumonia
(HAP) NOSOCOMIAL INFECTION, an
infection that was not found present
prior to hospital admission (w/in 48 hrs.)
Specific type: 64% isolated from the lung
of the pt were GRAM (+) cocci
S. Aureas BUT
My suspect: GRAM (-) bacilli
P. Aeroginosa
MOT: Contact, Airborne, Vehicle and or
Vector
(prevention UNIVERSAL PRECAUTION)
CDC staff handwash enough?
NICU 29%
ICU 81%
WARD 16%
OUTSIDE THE BOX
Possible due to? NOT IN
OUR HISTORY
Dx: Pneumonia (but hospital
acquired type in Hx)
Gram(-) GIT
?Endotracheal Intubation,
nasogastric tubing or enteral
feeding ASPIRATION
P.:Indwelling catheter
Gram(+) nose,Skin
?Bacteria,Viral,Fungi
COMMUNITY ACQUIRED P.
Other organism
21%P.Aeroginosa,9%Enterob
acter or 8%K.Pneumonia
DIAGNOSTIC ACCURACY
“controversial” bec. We have to be certain
what organism or PNEUMONIA is really
present.
LAB Dx: endotracheal aspiration, FOB
fiberoptic bronchoscope, gram staining,
BBS blinded bronchial sampling.
Sensitivity of this test ave. 95%
Empirical Antibiotic Tx for HAP
• Have to understand the local patterns of antibacterial resistance.
• If MRSA prevalent in the institution, Vancomycin
should be included can also use Quinupristindalfopristin and linezolid.
• KEY “broaden the spectrum of antibacterial
treatment and continued lab testing”
• DOC P.Aeruginosa =
Carbencillin + Aminoglycoside
STOP! DO NOT FORGET!
• SEPSIS most often complication of HAP,
so follow regimen for proper medication
administration.
• Electrolyte imbalance due to vomitting and
diarrhea.
t.y.
• Pulmonary Infections
•
Occurs in:
•
a. Loss or suppression of cough reflex
•
b. Injury to the mucocilliary apparatus
•
c. Interference with the phagocytic or
bacterial
action of alveolar
macrophages
•
d. Pulmonary congestion and edema
•
e. Accumulation of secretion