Hospital-acquired Pneumonia
- Hospital-acquired pneumonia is pneumonia occurring 48 hours or more after admission, and did not appear to be incubating on admission. See investigation and treatment guidelines in Hospital HealthPathways.
- Empiric treatment is based on pneumonia severity and risk for multidrug-resistant gram-negative bacilli (MDR-GNB).
Cover for MDR-GNB organisms if:
- MDR-GNB positive
- Current or recent inpatient in a high-risk ward (e.g. ICU, BMTU, SPCU) for 5 days or more
- Admission to overseas healthcare facility
- Travel to developing country in previous six months
- Household contact with MDR-GNB
- Residence or admission to any facility with high prevalence of MDR-GNB
- Broad-spectrum antimicrobial treatment.
- Severe hospital-acquired pneumonia is defined as the presence of one or more of the following:
- rapid progression of infiltrates
- severe sepsis/septic shock
- need for intubation
Pathogens
- Common: H. influenzae, S. pneumoniae, Gram-negative organisms
Drug Treatment
- Duration: usually 5–7 days, depending on severity. Consult Infectious Diseases/Clinical Microbiology if slow to settle.
Empiric
Non-severe disease and low risk for MDR-GNBs
amoxicillin+clavulanic acid
HMLSchedNZFPMLnoids
|
IV 1 g/200 mg every eight hours
then PO 500 mg/125 mg three times a day
|
Mild penicillin allergy
- fe = 0.9, consider adjusting dose if CrCl is reduced.
- Cefuroxime is not funded for this indication on prescription – ask your ward pharmacist to supply on discharge.
Severe penicillin allergy
AND EITHER
OR
Severe disease or high risk for MDR-GNBs
- Complex patient group – consult Infectious Diseases/Clinical Microbiology early.
piperacillin+tazobactam
HMLNZFPMLnoids
|
IV 4 g/500 mg every eight hours
|
- If still on piperacillin+tazobactam beyond 48 hours, consider measuring a trough concentration. Consult Infectious Diseases for interpretation.
- fe (piperacillin) = 0.8, fe (tazobactam) = 0.6, consider adjusting dose if CrCl reduced.
Mild penicillin allergy
- Meropenem rapidly and significantly reduces sodium valproate concentrations. Concomitant administration may precipitate seizures in patients with a pre-existing seizure disorder. Discuss alternative antibiotic options with Infectious Diseases/Clinical Microbiology.
- If still on meropenem beyond 48 hours, consider measuring a trough concentration. Consult Infectious Diseases for interpretation.
- fe = 0.7, start with full dose initially then consider extending dose interval and/or decreasing dose for subsequent doses if CrCl is reduced (< 30 mL/min). Consult pharmacist.
Severe penicillin allergy
Consult Infectious Diseases/Clinical Microbiology/Respiratory Medicine.
Nosocomial legionella infection (notifiable)
This is unusual. If in doubt consult Infectious Diseases/Clinical Microbiology/Respiratory Medicine.
Topic Code: 99247