Hospital-acquired pneumonia diagnostic algorithm: Difference between revisions
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== | ==Diagnostic Algorithm== | ||
Shown below is an algorithm for the diagnostic approach of Healthcare-associated pneumonia (HCAP), Ventilator-associated pneumonia VAP), and Hospital-acquired pneumonia (HAP).<ref>{{cite journal|title=Guidelines for the Management of Adults with Hospital-acquired, Ventilator-associated, and Healthcare-associated Pneumonia|journal=American Journal of Respiratory and Critical Care Medicine|volume=171|issue=4|year=2005|pages=388–416|issn=1073-449X|doi=10.1164/rccm.200405-644ST}}</ref> | |||
<div style="font-size:85%; width: 80%; float:left"> | <div style="font-size:85%; width: 80%; float:left"> | ||
{{familytree/start}} | {{familytree/start}} | ||
{{familytree | | | | | | | A01 | {{familytree | | | | | | | A01 | | | | | | | | A01=<div style="float: left; text-align: center; width: 25em; padding:0.5em;">'''High suspicion of HAP, VAP or HCAP'''</div> }} | ||
{{familytree | | | | | | | |! | {{familytree | | | | | | | |!| | | | | | | | | }} | ||
{{familytree | | | | | | | B01 | {{familytree | | | | | | | B01 | | | | | | | | B01=<div style="float: left; text-align: left; width: 25em; padding:0.5em;">Obtain sputum or respiratory secretions sample for culture and microscopy</div> }} | ||
{{familytree | | | | | | | |! | {{familytree | | | | | | | |!| | | | | | | | | }} | ||
{{familytree | | | | | | | C01 | {{familytree | | | | | | | C01 | | | | | | | | C01=<div style="float: left; text-align: left; width: 25em; padding:0.5em;">'''Does the patient has any of the following risk factors for MDR infection?'''<br> | ||
* Antimicrobial therapy in preceding 90 | * Antimicrobial therapy in preceding 90 days | ||
* Current hospitalization of 5 | * Current hospitalization of ≥ 5 days | ||
* High frequency of antibiotic resistance in the community or in the specific hospital unit | * High frequency of antibiotic resistance in the community or in the specific hospital unit | ||
* Immunosuppressive disease and/or therapy | * Immunosuppressive disease and/or therapy | ||
* Presence of risk factors for HCAP: | * Presence of risk factors for HCAP: | ||
:* Hospitalization | :* Hospitalization ≥2 days in the preceding 90 days | ||
:* Residence in a nursing home or extended care facility | :* Residence in a nursing home or extended care facility | ||
:* Home infusion therapy (including antibiotics) | :* Home infusion therapy (including antibiotics) | ||
:* Chronic dialysis within 30 | :* Chronic dialysis within 30 days | ||
:* Home wound care | :* Home wound care | ||
:* Family member with multidrug-resistant pathogen | :* Family member with multidrug-resistant pathogen | ||
</div> }} | </div> }} | ||
{{familytree | | | | | | {{familytree | | | |,|-|-|-|^|-|-|-|.| | | | | | }} | ||
{{familytree | | | | | {{familytree | | | D01 | | | | | | D02 | | | | D01=<div style="float: left; text-align: center; width: 14em;">'''Yes''' | ||
{{familytree | | | | |`|-|-|v|-|-|' | ---- | ||
{{familytree | | | | | | | E01 | Start empirical therapy with combined broad spectrum antibiotics <br> [[Hospital-acquired pneumonia medical therapy| Click here for more detail]] </div>| D02=<div style="float: left; text-align: center; width: 14em;">'''No''' | ||
---- | |||
Start empirical therapy with limited spectrum antibiotics <br> [[Hospital-acquired pneumonia medical therapy| Click here for more detail]] </div> }} | |||
{{familytree | | | | |`|-|-|v|-|-|'| | | | | | }} | |||
{{familytree | | | | | | | E01 | | | | | | | | E01=<div style="float: left; text-align: left; width: 25em; padding:0.5em;">After 2-3 days, check cultures and assess the clinical response based on: | |||
{{col-begin|100%}}{{col-break|50%}} | {{col-begin|100%}}{{col-break|50%}} | ||
* Temperature | * Temperature | ||
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*Sputum production | *Sputum production | ||
*Hemodynamic status{{col-end}}</div> }} | *Hemodynamic status{{col-end}}</div> }} | ||
{{familytree | | | | | | | |! | {{familytree | | | | | | | |!| | | | | | | | | }} | ||
{{familytree | | | | | | | F01 | {{familytree | | | | | | | F01 | | | | | | | | F01=<div style="float: left; text-align: left; width: 25em; padding:0.5em;">'''Does the patient improved his clinical status after 48-72 hours?''' </div> }} | ||
{{familytree | | | | | | {{familytree | | | |,|-|-|-|^|-|-|-|.| | | | | | }} | ||
{{familytree | | | | | {{familytree | | | G01 | | | | | | G02 | | | | G01=<div style="float: left; text-align: center; width: 14em;">'''Yes'''<br>Assess culture results</div>| G02=<div style="float: left; text-align: center; width: 14em;"> '''No''' <br>Assess culture results</div> }} | ||
{{familytree | | | | | | | | {{familytree | |,|-|^|-|.| | | |,|-|^|-|.| | | | }} | ||
{{familytree | | | | | | | | {{familytree | H01 | | H02 | | H03 | | H04 | | | | H01=<div style="float: left; text-align: center; width: 14em; padding:0.5em;">'''Positive''' Culture </div>|H02=<div style="float: left; text-align: center; width: 14em; padding:0.5em;">'''Negative''' Culture </div>|H03=<div style="float: left; text-align: center; width: 14em; padding:0.5em;">'''Positive''' Culture</div>|H04=<div style="float: left; text-align: center; width: 14em; padding:0.5em;">'''Negative''' Culture </div>}} | ||
{{familytree | | | | | | | | {{familytree | |!| | | |!| | | |!| | | |!| | | | }} | ||
{{familytree | | | | | | | | {{familytree | H01 | | H02 | | H03 | | H04 | | | | H01=<div style="float: left; text-align: center; width: 14em; padding:0.5em;">De-escalate antibiotics, treat for 7-8 more days and re-evaluate</div>|H02=<div style="float: left; text-align: center; width: 14em; padding:0.5em;">Consider stopping antibiotics </div>|H03=<div style="float: left; text-align: center; width: 14em; padding:0.5em;">Adjust antibiotic regimen based on culture susceptibility, look for other infection sites and complications</div>|H04=<div style="float: left; text-align: center; width: 14em; padding:0.5em;">Look for other pathogens, infection sites and complications </div>}} | ||
{{familytree/end}}</div> | {{familytree/end}}</div> | ||
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<br><br><br><br><br><br><br> | |||
<br style="clear:left" /> | |||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
Latest revision as of 13:55, 5 April 2018
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Alejandro Lemor, M.D. [2]
Diagnostic Algorithm
Shown below is an algorithm for the diagnostic approach of Healthcare-associated pneumonia (HCAP), Ventilator-associated pneumonia VAP), and Hospital-acquired pneumonia (HAP).[1]
High suspicion of HAP, VAP or HCAP | |||||||||||||||||||||||||||||||||||
Obtain sputum or respiratory secretions sample for culture and microscopy | |||||||||||||||||||||||||||||||||||
Does the patient has any of the following risk factors for MDR infection?
| |||||||||||||||||||||||||||||||||||
After 2-3 days, check cultures and assess the clinical response based on:
| |||||||||||||||||||||||||||||||||||
Does the patient improved his clinical status after 48-72 hours? | |||||||||||||||||||||||||||||||||||
Yes Assess culture results | No Assess culture results | ||||||||||||||||||||||||||||||||||
Positive Culture | Negative Culture | Positive Culture | Negative Culture | ||||||||||||||||||||||||||||||||
De-escalate antibiotics, treat for 7-8 more days and re-evaluate | Consider stopping antibiotics | Adjust antibiotic regimen based on culture susceptibility, look for other infection sites and complications | Look for other pathogens, infection sites and complications | ||||||||||||||||||||||||||||||||
References
- ↑ "Guidelines for the Management of Adults with Hospital-acquired, Ventilator-associated, and Healthcare-associated Pneumonia". American Journal of Respiratory and Critical Care Medicine. 171 (4): 388–416. 2005. doi:10.1164/rccm.200405-644ST. ISSN 1073-449X.