What are the important considerations in treatment selection for nosocomial pneumonia?

Updated: Apr 15, 2021
  • Author: Kartika Shetty, MD, FACP; Chief Editor: John L Brusch, MD, FACP  more...
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An important caveat is to differentiate P aeruginosa colonization from actual lung infection. P aeruginosa pneumonia is characterized by fever, cyanosis, hypotension, and rapid cavitation (< 72 hours) on chest radiography. Sputum recovered from these cases is typically greenish due to the pyocyanin pigment that is produced by the organism when it invades tissue. This is usually accompanied by an almond odor.

Enterobacter species do not typically cause hospital-acquired pneumonia (HAP)/ventilator-associated pneumonia (VAP). S maltophilia and B cepacia are common colonizers of respiratory secretions, but they rarely, if ever, cause nosocomial pneumonia in otherwise healthy hosts; however, they are colonizers/potential pathogens in patients with bronchiectasis or cystic fibrosis.

S aureus (MSSA/MRSA) commonly colonizes respiratory secretions (30%-50%) but rarely, if ever, causes necrotizing cavitary nosocomial pneumonia. Oropharyngeal anaerobes are unimportant from a therapeutic standpoint.

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