加拿大HAP指南.pptVIP

New Canadian Guidelines for Hospital-Acquired Pneumonia (HAP) Ventilator-Associated Pneumonia (VAP) Dr. Coleman Rotstein University of Toronto University Health Network Toronto, Ontario Disclosure Statement Financial Conflicts of Interest Grant/Research Support: Astellas, Basilia, Johnson Johnson, Pfizer, Wyeth, Merck, Schering Consultant: Astellas, Bayer, Merck, Pfizer, Schering, Wyeth Speakers Bureau: Bayer, Merck, Pfizer, Wyeth Guideline Formulation Participants Association of Medical Microbiology and Infectious Disease Canada (AMMI Canada) Canadian Thoracic Society (CTS) Intensivists Pharmacists Epidemiology of HAP-VAP Hospital-Acquired Pneumonia (HAP): Definitions HAP: Arises 48 hours or more after hospital admission Is not incubating at the time of admission Ventilator-associated pneumonia (VAP): Arises 48-72 hours or more after endotracheal intubation Healthcare-associated pneumonia (HCAP): Arises within 90 days of having been admitted to an acute care facility pt. has resided in a nursing home or LTCF. HAP: Impact Accounts for ~15% of all nosocomial infections (2nd most common cause of NI’s after UTI’s) Number of cases per year in US: ~275,000 Extra days in the hospital: 4-9 days Average extra days in ICU: 4.3 days Direct cost (estimated) of excess hospital stay = $1.5 billion per year INCIDENCE OF NOSOCOMIAL INFECTIONS IN COMBINED MEDICAL-SURGICAL ICU’s Medical Patients Surgical Patients Pneumonia 30% Pneumonia 33% UTI 30% UTI 18% Bloodstream SSTI 14% infection 16% Bloodstream Lower resp. infection 13% tract 6% Lower resp. (not pneumonia) tract 6% (not pneumonia) (Richards et al. Infect Control Hosp Epidemiol 2000;21:510-515) Risk Factors for HAP VAP Risk Factors for HAP/VAP Pathogenesis of HAP/VAP Pathogenesis of HAP/VAP Causative Pathogens Classification of HAP VAP: Risk St