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:

• ENT consult
• Remove nasogastric/nasoendotracheal tube
• Semi-recumbent (30-45°) positioning
• Sinus aspiration for C&S:

  • tailor antibiotics to C&S results.

- If no response to therapy in 7 days, insertion of a drainage catheter should be considered.

Enterobacterales
P. aeruginosa
Acinetobacter spp
S. aureus/MRSA
Yeast

Severe

or

Facial fractures, head trauma, CNS infection/meningitis suspected