Diagnosis and Treatment of Pneumonia

exp date isn't null, but text field is

Intubated Patients:

1. Identify patient with suspected pneumonia (need 3 of 6 criteria)
   • Patient on mechanical ventilation >2 days
   • Baseline period of stability or improvement, followed by sustained period of worsening oxygenation
   • Ventilator-Associated Condition (VAC)
   • General, objective evidence of infection/inflammation
   • Infection-Related Ventilator-Associated Complication (IVAC)
   • Positive results of laboratory/microbiological testing
2. When performing quantitative BAL (Mini BAL is an acceptable alternative when BAL is contraindicated or not feasible – but if left lower lobe infiltrate, prefer formal bronch with BAL since mini-BAL goes down right lower lobe only)
   • Review CXR, determine which side the infiltrate is on (left vs. right)
   • Flexible bronchoscopy with BAL on non-infected side first
   • Lavage with 20 cc of nonbacteriostatic saline on each side, suction as much as possible
   • Send specimen for Gram stain and quantitative culture
   • For hospitalized patients start Zosyn, Vancomycin, and Tobramycin empirically. If allergic to any of these agents, or has a history of resistant organisms, use ICU HAP/VAP/Sepsis order set for guidance on alternative antibiotic selection. Narrow antibiotics to singe agent when cultures available.
3. Culture results
   • if 10⁴ or greater, then continue antibiotic coverage based on sensitivities
     • Treat for 8 days total with the correct antibiotics
   • If patient has recurrent pneumonia with same organism or MDR pneumonia, treat for 15 days.

 

Extubated Patients (without tracheostomy):

1. Identify patient with suspected pneumonia (need 3 of 5 criteria)
   • new or changing infiltrate on CXR
   • increasing WBC
   • hypoxia
   • fever
   • increasing sputum production
2. Follow antibiotic guidelines as above for the specific organisms and duration of therapy