Hospital-acquired pneumonia diagnostic algorithm: Difference between revisions

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Revision as of 17:15, 11 December 2014

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Alejandro Lemor, M.D. [2]

Overview

Diagnostic Algorithm

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?

Antimicrobial therapy in preceding 90 d
Current hospitalization of 5 d or more
High frequency of antibiotic resistance in the community or in the specific hospital unit
Immunosuppressive disease and/or therapy
Presence of risk factors for HCAP:

Hospitalization for 2 d or more in the preceding 90 d
Residence in a nursing home or extended care facility
Home infusion therapy (including antibiotics)
Chronic dialysis within 30 d
Home wound care
Family member with multidrug-resistant pathogen

Yes

Start empirical therapy with combined broad spectrum antibiotics
Click here for more detail

No

Start empirical therapy with limited spectrum antibiotics
Click here for more detail

After 2-3 days, check cultures and assess the clinical response based on:

Temperature
WBC count
Chest X-ray

Oxygenation
Sputum production
Hemodynamic status

Does the patient improved his clinical status after 48-72 hours?

Yes
Assess culture results

No
Assess culture results

@@ Line 8: / Line 8: @@
 <div style="font-size:85%; width: 80%; float:left">
 {{familytree/start}}
-{{familytree | | | | | | A01 | | | | | | | | A01=<div style="float: left; text-align: center; width: 28em; padding:0.5em;">'''High suspicion of HAP, VAP or HCAP'''</div> }}
+{{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 | | | | | | B01 | | | | | | | | B01=<div style="float: left; text-align: left; width: 28em; padding:0.5em;">Obtain sputum or respiratory secretions sample for culture and microscopy</div> }}
+{{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 | | | | | | C01 | | | | | | | | C01=<div style="float: left; text-align: left; width: 28em; padding:0.5em;">'''Does the patient has any of the following risk factors for MDR infection?'''<br>
+{{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 d
 * Current hospitalization of 5 d or more
@@ Line 26: / Line 26: @@
   </div> }}
 {{familytree | | | |,|-|-|^|-|-|.| | | | | | }}
-{{familytree | | | D01 | | | | D02 | | | | D01=<div style="float: left; text-align: center; width: 12em; padding:0.5em;">'''Yes'''</div><div style="float: left; text-align: left; width: 12em; padding:0.5em;">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: 12em; padding:0.5em;"> '''No'''<br> </div><div style="text-align: left"> Start empirical therapy with limited spectrum antibiotics <br> [[Hospital-acquired pneumonia medical therapy| Click here for more detail]] </div> }}
+{{familytree | | | D01 | | | | D02 | | | | D01=<div style="float: left; text-align: center; width: 12em; padding:0.5em;">'''Yes'''</div>
+----
+<div style="text-align: left;">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: 12em; padding:0.5em;">'''No'''</div>
+----
+<div style="text-align: left;"> 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: 28em; padding:0.5em;">After 2-3 days, check cultures and assess the clinical response based on:
+{{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%}}
 * Temperature
@@ Line 38: / Line 42: @@
 *Hemodynamic status{{col-end}}</div> }}
 {{familytree | | | | | | |!| | | | | | | | | }}
-{{familytree | | | | | | F01 | | | | | | | | F01=<div style="float: left; text-align: left; width: 28em; padding:0.5em;">'''Does the patient improved his clinical status after 48-72 hours?''' </div> }}
+{{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 | | | G01 | | | | | G02 | | | | G01=<div style="float: left; text-align: center; width: 12em; padding:0.5em;">'''Yes'''<br>Assess culture results</div>| G02=<div style="float: left; text-align: center; width: 12em; padding:0.5em;"> '''No''' <br>Assess culture results</div> }}
@@ Line 44: / Line 48: @@
 {{familytree | H01 | | H02| |H03 | | H04 | | | | H01=<div style="float: left; text-align: left; width: 10em; padding:0.5em;"> </div>|H02=<div style="float: left; text-align: left; width: 10em; padding:0.5em;"> </div>|H03=<div style="float: left; text-align: left; width: 10em; padding:0.5em;"> </div>|H04=<div style="float: left; text-align: left; width: 10em; padding:0.5em;"> </div> }}
 {{familytree | | | | | | | |!| | | | | | | | | }}
-{{familytree | | | | | | | B01 | | | | | | | | B01=<div style="float: left; text-align: left; width: 28em; padding:0.5em;"> </div> }}
+{{familytree | | | | | | | B01 | | | | | | | | B01=<div style="float: left; text-align: left; width: 25em; padding:0.5em;"> </div> }}
 {{familytree/end}}</div>
 ==References==
 {{reflist|2}}

Hospital-acquired pneumonia diagnostic algorithm: Difference between revisions

Revision as of 17:15, 11 December 2014

Overview

Diagnostic Algorithm

References

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