PIAC Case Series
Case 04 - Crystal, 45 years of age
Crystal is a 45 y/o obese WF who undergoes laparoscopic cholecystectomy; she is admitted postop with poorly controlled pain. She has COPD and smokes 2 ppd.
On postop day 2 the patient develops a fever to 38.9 and cough; CXR shows new LLL infiltrate
1) What were Crystal's predisposing risk factors for HCAP (health care associated pneumonia)?
- What are the likely causative organisms?
- What preventative measures are utilized to prevent HCAP?
- Predisposing risk factors:
- For Crystal - pre-existing lung disease, smoking, recent intubation
- Other risk factors - over-sedation, PPI use, aspiration
- Likely causative organisms:
- Early onset: Strep pneumo, hemophilus, moraxella,
- Late onset (hospital day 5 or later): aerobic gram neg bacilli (Pseudomonas, Enterobacter, etc.), Staph aureus (esp MRSA)
- Preventative measures:
- Early ambulation
- Incentive spirometry
- Judicious use of PPI
- Measures to decrease risk of aspiration
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