Definition of Hospital-acquired Infection

• Onset of infection 48 hours or more after hospital admission
  OR
• 
• Infection present on admission but patient is within 10 days of previous in-patient stay
• Clinical diagnosis: A new / progressive infiltrate on chest X-ray plus 2 or more of the following clinical features represent the most accurate clinical criteria for starting empiric antibiotic therapy:

                - Temperature <36.0°C or >38.0°C
                - Leucocytosis (>12x10⁹/L) or leukopenia (<4 x10⁹/L)
                - Purulent respiratory secretions 

Severity
(classification)

1st line oral/iv antibiotics

Anaphylactic penicillin allergy

(see explanatory notes)

A/B

Minor to
severe infection

Review doses in renal impairment

CO-AMOXICLAV 625mg po tds

Discuss with senior member of the clinical team and if necessary, the Consultant Microbiologist

C

Severe life threatening infection

Review doses in renal impairment

• Send urine sample to microbiology for pneumococcal/legionella antigen tests

TAZOCIN 4.5g iv tds (monotherapy)

• If definite history of rash allergy but no anaphylactic penicillin allergy (see explanatory notes), use:

MEROPENEM 1g iv tds

• If unresponsive to treatment or previously treated with antibiotics above discuss with senior member of the clinical team and if necessary, the Consultant Microbiologist

• If suspected/confirmed MRSA ADD:

Teicoplanin 400mg iv every 12 hours for 3 doses then 600mg iv once daily and review with consultant microbiologist

Maintain treatment pending pre-dose (trough) level on Day 5

Mild to moderate infection (10-20mg/l)

Severe(>20mg/l,<60mg/l)

Re-assay after 6 to 8 days

• Note that the antibiotic regimens above provide adequate cover for aspiration pneumonia occurring in hospital

REVIEW THERAPY with culture results at 48-72 hours. If initial diagnosis of hospital acquired pneumonia is in doubt (i.e. absence of clinical features above) and cultures are negative then consider stopping antibiotics

• Send urine sample to microbiology for pneumococcal/legionella antigen tests

Discuss with senior member of the clinical team and if necessary, the Consultant Microbiologist

IV to Oral Switch

(explanatory notes)

CO-AMOXICLAV 625mg tds

Discuss with senior member of the clinical team and if necessary, the Consultant Microbiologist

Typical duration of therapy for hospital acquired pneumonia is 7- 8 days