Hospital-acquired ≥ 4 days hospitalization
- Majority of cases occur in second week of hospitalization.
- Risk factors:
- mechanical ventilation
- facial/cranial fractures
- nasal packing
- nasogastric/nasoendotracheal tubes
- otitis media post head trauma
- corticosteroid therapy
- prior antibiotic use.
- Black, necrotic tissue or discharge in patients with poorly controlled diabetes/ketoacidosis, or with significant immunosuppression may indicate mucormycosis. Recommend urgent ENT/ID consult.
Recommend:
- Remove nasogastric/ nasoendotracheal tube
- Semi-recumbent (30-45°) positioning
-
Sinus aspiration for C&S:
- tailor antibiotics to C&S results
- if Pseudomonas/Acinetobacter cultured, consider combination therapy with tobramycin.
- Surgical drainage usually needed. Consult ENT.
Usual Pathogens
S. aureus/MRSA
Enterobacterales
Occasionally:
Anaerobes
P. aeruginosa
Yeast
| Empiric Therapy | Duration | |
|---|---|---|
| Ceftriaxone | 100mg/kg IV daily | 7-10 days |
| + | ||
| Gentamicin | 7mg/kg IV q24h |
Severe
| Empiric Therapy | Dose | Duration |
|---|---|---|
| Piperacillin-tazobactam | 240-300mg piperacillin/kg/d IV div q6-8h | 7-10 days |
Facial fractures, head trauma, CNS infection/meningitis suspected
| Empiric Therapy | Duration | |
|---|---|---|
| Meropenem | 120mg/kg/d IV div q8h | 7-10 days |