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CDHB

Hospital Acquired Pneumonia

• The incidence of Hospital Acquired Pneumonia is around 0.7% in adult inpatients at Christchurch Hospital.
• In post-operative patients presentation is usually with fever, deteriorating gas exchange and CXR infiltration.
• Intensive post-operative physiotherapy may help prevent hospital acquired pneumonia.
• Medical patients may become more unwell very quickly - the diagnosis should be suspected in any medical patient developing a fever.

Investigations for Hospital Acquired Pneumonia

• Sputum sample - involve a physiotherapist if necessary.
• Blood cultures - 2 sets. 10 mL in each bottle.
• CBC + diff.
• CXR.

Management of Hospital Acquired Pneumonia

• Physiotherapy - especially if patient has underlying lung disease.
• Oxygen if indicated.
• Bronchodilators if history of airflow obstruction.
• Antibiotics:
  • Mild/moderate:
    • Amoxicillin/ clavulanate 1.2 g IV q8h.
    • If mild penicillin allergy, give cefuroxime 1.5 g IV q8h.
    • If severe penicillin allergy, give gentamicin (see the gentamicin/tobramycin dosing guidelines in the Pink Book) and clindamycin 600 mg IV q6h.
  • Severe (criteria include tachypnoea >30/min, urea >7 mmol/L, hypotension, PaO₂ <55 mm Hg on oxygen, anyone in ICU, age >65):
    • Piperacillin/tazobactam 4 g/500 mg IV q8h and gentamicin 5 mg/kg IV initial dose.
    • If mild penicillin allergy, give meropenem 1 g IV q8h.
    • If severe penicillin allergy, consult departments of Infectious Diseases/ Clinical Microbiology/ Respiratory Medicine.

      Note: Nosocomial legionella infection (notifiable) is unusual. If in doubt consult Infectious Diseases/ Clinical Microbiology/ Respiratory Medicine.

References:

British Thoracic Society Guidelines. Thorax 2009, Guidelines for the management of community acquired pneumonia in adults: update 2009 http://www.brit-thoracic.org.uk/Portals/0/Clinical%20Information/Pneumonia/Guidelines/CAPGuideline-full.pdf

Infectious Disease Society of America/American Thoracic Society Consensus Guidelines on the Management of Community-Acquired Pneumonia in Adults. Clin Inf Dis 2007;44:S7-S72, http://www.idsociety.org/

American Thoracic Society Document: Guidelines for the Management of Adults with Hospital-acquired, Ventilator-associated, and Healthcare-associated Pneumonia. Am J Resp Crit Care Med 2005;171:388-416. http://www.idsociety.org/

Topic Code: 1663