Time to clinical stability in HCAP in a tertiary center hospital in Kuala Lumpur

Abstract

Background: Antibiotics treatment for HCAP (health care associated pneumonia) has been a source of controversy depending on the severity and risk for resistant organisms. Time to clinical stability for this group of patients is not well documentedTabled 1Methods and materials: Type1 (CAI)No contact with health care system in the last 90 daysAND no prior antibiotic treatment in the last 90 daysAND young patient with no or few comorbid conditionsIV Augmentin + IV AzithromycinIf severe CAP: Ceftriaxone + AzithromycinType 2 (HAI)Contact with health care system in past three monthsOR < one week in the hospitalOR <48 h in ICU (eg. admission in hospital or nursing home), invasive procedureOR recent antibiotic therapy in last three monthsOR old patients (>65 years) with > two co-morbiditiesPiperacillin/Tazobactamor Cefepime ± AmikacinType 3 (NI)Hospitalization > five to seven days ± infections following major invasive proceduresOR recent & multiple antibiotic therapiesOR old patients (>65 years) + multiple comorbidities (eg. Structural lung disease, immunodeficiency)Severe sepsis/septic shock: Imipenem/meropenem + VancomycinOtherwise Piperacillin/Tazobactam ± AmikacinMRSA strongly suspected: Vancomycin Open table in a new tab Results: There were 58 male patients (56.9%). Most were from type 2 group [60 patients (54.5%)], type 1 [40 patients (36.4%)] and type 3 [10 patients (9.1%)]. 81% of patients in Type 2 were undertreated but achieved similar clinical stability at day 4 compared to other groups Conclusion: Patients with type 2 risk factors similar to HCAP may still benefit from less broad spectrum antibiotics such as augmentin and ceftriaxone. Newer methods and risk scores are very much needed to improve accuracy in predicting MDR pathogens.