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Factori de risc pentru cu germeni multi-rezisten i n HAP, HCAP VAP

Folosirea antibioticelor n antecedente - p la 90 de zile Durata episodului curent de spitalizare n= Frecven a crescut a rezisten ei la antibiotice n comunitate sau n unitatea n care este internat

pacientul Prezen a factorilor de risc pentru HCAP:

- spitaliz = n antecedente (pn la 90 de zile) - d - pacien i cu spitaliz ri prelungite frecvente - pacien i din centre de ngrijire - terapii n ambulator (incluznd antibiotice) - membri de familie cu germeni multi-rezisten i

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Suspiciune de HAP, VAP sau HCAP

Obtinerea secretiilor de la nivelul tractului respirator pentrudiagnosticul microbiologic: culturi (cantitativ si semicantitativ) si microscopie

Initierea terapiei antibiotice empirice conform algoritmului si datelormicrobiologice locale (terapia NU va fi initiata daca suspiciunea de pneumonie

este minora SI microscopia este negativa)

Ziua 2&3: analiza raspunsului microbiologic & clinic(temperatura, leucocite, RX toracica, sputa, modificari hemodinamice, SO2)

Evolutie favorabila la 48-72 ore

Nu Da

Culturi - Culturi + Culturi - Culturi +

Investigatii pentru altipatogeni, complicatii, alt

diagnostic saualta localizare a infectiei

Modificarea schemei atbInvestigatii pentru alti

patogeni, complicatii, altdiagnostic sau

alta localizare a infectiei

Considera stopareaterapiei atb

DeescaladareTratament atb 7-8 z

Reevaluare

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Terapie antibiotica empiricaSuspiciune de HAP, VAP sau HCAP

Debut tardiv (> 5 zile) sauFactori de risc pentru GMR prezenti

Antibiotic recomandat

Streptococcus Pneumonie Haemophillus influenzae MSSA Bacili gram-negativ sensibili E.coli K. pneumonie Enterobacter spp. Proteus spp. Seratia

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Germeni poten iali Schema terapeutic recomandat

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PLUS

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PLUS

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