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Pneumonia
Internal Medicine Mini-Lecture
Revised Jan 2016
Learning Objectives
Definition of Hospital-Acquired Pneumonia (HAP).
Risk factors associated with HAP.
Current treatment guidelines
Clinical Case
68-yo female with insulin-dependent diabetes presents with 2-
day history of fever, cough, and pleuritic chest pain. She had
knee replacement surgery 60 days ago and spent 2 weeks at a
rehabilitation facility.
Source: American Thoracic Society, Infectious Diseases Society of America. Guidelines for the
management of adults with hospital-acquired, ventilator-associated, and healthcare-associated
pneumonia. Am J Respir Crit Care Med 2005; 171:388.
Treatment
For late onset or MDR risk factors present:
Pathogens include Pseudomonas, Klebsiella ESBL,
Acinetobactor, MRSA, Legionella.
Recommended antibiotics: Cefepime or imipenem or Zosyn
PLUS levofloxacin or gentamicin PLUS vancomycin or linezolid
Source: American Thoracic Society, Infectious Diseases Society of America. Guidelines for the
management of adults with hospital-acquired, ventilator-associated, and healthcare-associated
pneumonia. Am J Respir Crit Care Med 2005; 171:388.
Special considerations
No evidence indicates that HAP or VAP caused by Pseudomonas
species requires combination therapy or that a synergistic
combination improves outcomes.