Pulmonary Medicine HAP PDF

Respiratory Medicine Respiratory infections Nosocomial Pneumonia 26/10/2024 Dr. Mahad Sadik Mukhtar Pulmonologist MD Respiratory Medicine  LECTURE CONTENTS  CASE SCENARIO INTRODUCTION  EPIDEMIOLOGY  TYPES OF HAP  CAUSES OF HAP  PATHO...

Respiratory Medicine Respiratory infections Nosocomial Pneumonia 26/10/2024 Dr. Mahad Sadik Mukhtar Pulmonologist MD Respiratory Medicine  LECTURE CONTENTS  CASE SCENARIO INTRODUCTION  EPIDEMIOLOGY  TYPES OF HAP  CAUSES OF HAP  PATHOPHYSIOLOGY  CLINICAL FEATURES  DIAGNOSIS OF HAP  MANAGEMENT OF HAP  CASE SCENARIO  A 55-year-old man with a history of peripheral vascular disease, who presents with a complaint of a left foot ulcer and pain when walking short distances, is found to have a popliteal stenosis and admitted for re-vascularisation.  Four days after admission, on postoperative day 3, he develops shortness of breath, hypoxia, and a productive cough. Auscultation of his chest reveals decreased breath sounds at the lower aspect of the right side of his chest.  His morning leukocyte count is slightly higher than the day before at 11,000 cells/mL 3.  An anterior-posterior bedside chest x-ray reveals right lower lobe opacity.  Pneumonia is an infection of the lungs that can cause mild to severe illness in people of all ages.  The word "pneumonia" takes its origin from the ancient Greek word "pneumon," which means "lung," so the word "pneumonia" becomes "lung disease."  Medically it is an inflammation of one or both lungs' parenchyma that is more often, but not always, caused by infections.  Nosocomial pneumonia or hospital-acquired pneumonia (HAP) is defined as pneumonia that occurs 48 hours or more after hospital admission and is not present at the admission time.  Ventilator-associated pneumonia (VAP) represents a significant sub-set of HAP occurring in intensive care units (ICUs) and is defined as pneumonia that occurs more than 48 to 72 hours after tracheal intubation and is thought to affect 10% to 20% of patients receiving mechanical ventilation for more than 48 hours.  EPIDEMIOLOGY HAP occurs at a rate of 5 to 10 per 1000 hospital admissions and is considered the most common cause of hospital- acquired infection in Europe and the United States. Over 90% of pneumonia episodes developing in ICUs occur in patients who are intubated and mechanically ventilated. EPIDEMIOLOGY TYPES OF HAP HAP CLASSIFICATION  CAUSES AND RISK FACTORS Common pathogens of HAP and VAP include aerobic gram-negative bacilli (e.g. Pseudomonas aeruginosa, Escherichia coli, Klebsiella pneumoniae, Enterobacter spp, Aci netobacter spp) and gram-positive cocci (e.g., Staphylococcus aureus, which includes methicillin- resistant S. aureus, Streptococcus spp). Continue… Continue………. PATHOPHYSIOLOGY CLINICAL FEATURES Physical Exam INVESTIGATIONS Continue…… IMAGING IMAGING IMAGING TREATMENT OF HAP