Pulmonology
Hospital-Acquired Pneumonia
병원내폐렴
Pneumonia occurring ≥48 hrs after admission (MDR organism risk)
- How common
- 1% of inpatients
- Typical age
- Hospitalized patients
What is it?
Multidrug-resistant hospital pathogens (MRSA, Pseudomonas) invade lungs of compromised hosts.
Commonly affected: Dependent lobes (usually RLL)
How it develops
- Oropharyngeal colonizationRapid colonization after admission
- MicroaspirationMore common with reduced consciousness
- Alveolar infectionMDR organisms invade alveoli
- Severe consolidationProgresses to severe sepsis/ARDS
Symptoms
- New feverAfter 5 days of admission
- Dyspnea/hypoxiaIncreased oxygen requirements
- Cough/sputumWorsens progressively
- Altered mental statusEspecially in elderly
How it is examined
- Sputum Gram/cultureEssential to identify MDR organisms
- Blood culturesObtain before antibiotics
Imaging
New infiltrate or consolidation.
- New infiltrate
Chest CT for complications.
- Necrosis/abscess
Non-surgical care
- Broad-spectrum empiric AbxPiperacillin-tazobactam or cefepime + vancomycin
- Cover MRSA + PseudomonasVancomycin + antipseudomonal
- De-escalate by cultureNarrow spectrum at 48–72 hrs
Conservative options are generally tried first. Medications listed here can have side effects — discuss them with your prescriber.
When surgery is considered
For abscess drainage
Procedures that may be discussed
- Chest tube or VATS
Outlook
HAP mortality 20–50%; VAP mortality higher.