121 - Pneumonia Flashcards
Pneumonia is an __ of the lung’s __
inflammation
parenchyma
Pneumocystis pneumonia and viral pneumonia usually involve the __ and are not __
alveoli
interstitium
What are the 4 categories of pneumonia?
CAP- community acquired pneumonia
HAP- hospital acquired pneumonia
VAP- ventilator acquired pneumonia
MDR-multidrug resistant pneumonia
What is the most common CAP pathogen?
Streptococcus pneumoniae
What are the typical CAP pathogens? 5
S. pneumoniae H. influenza S. aureus Klebsiella pneumoniae Pseudomonas aeruginosa
What are the atypical CAP pathogens? 4
Chlamydia pneumoniae
Mycoplasma pneumoniae
Legionella
Viruses (Influenza/adenovirus/human metapneumovirus/RSV)
10-15% of CAP are __ combining both __ and __ pathogens
polymicrobial
typical
atypical
__ pathogens tend to complicate and form __, __, and __
anaerobic
abscess
empyema
parapneumonic effusions
Alcoholism typically cause CAP due to __, __, __, __
strep pneumoniae
oral anaerobes
Klebsiella pneumoniae
acinetobacter
COPD/smoking typically cause CAP due to __, __, __, __
H. influenza
pseudomonas
legionella
strep pneumoniae
Dementia/stroke typically cause CAP due to __, __
oral anaerobes
G (-) enteric bacteria
Lung abscess typically cause CAP due to __, __, __, __
CA-MRSA
oral anaerobes
tuberculosis
atypical bacteria
Travel to southeast Asia may cause CAP due to __, __
Hantavirus
coccidioides app
When on a cruise sheep or in an hotel for > 2 weeks, CAP may develop, usually due to __
legionella
Exposure to birds/bats may cause CAP due to __, __
H capsulatum
Chlamydia psittaci
Exposure to goats/cats may cause CAP due to __, __
coxiella burnetii (Q fever)
__% of CAP patients get ___ again within a __ from release
18
readmitted
month
Mention 5 RF for CAP
alcoholism asthma immunosuppression hospitalization age >=70
What are the RF for pneumococcal pneumonia? 6
dementia seizures HF COPD/smoking alcoholism HIV
RF for legionella include 7
diabetes malignancy RF HIV smoking male cruise/hotel
Pneumatoceles = __
intrapulmonary gas-filled cystic spaces
Pneumatoceles suggest __ infection
S. aureus
Cavitary lesion in the upper lobe suggest __ infection
Tuberculosis
What are the 6 ways in which we can diagnose the etiology of CAP?
G stain + phlegm culture blood culture urine antigen PCR serology biomarkers /
Urine antigen allows to look for __ and __.
pneumococcus
legionella
The typical biomarkers used for pneumonia diagnosis are __ and __
CRP
procalcitonin
Procalcitonin is used to differentiate between __ and __ infection
viral
bacterial
What are the two criteria scales we use to decide if a CAP patients should be hospitalized or not?
PSI (pneumonia severity index)
CRUB 65
CRUB 65= __
Confusion RR >= 30/min Urea> 7mmol/L BP (systolic <= 90 mmHg, diastolic <= 60 mmHg) 65 <= age
CURB= 0: __
CURB= 1-2: __
CURB> 3: __
outpatient, mortality 1.5% within 30 days
hospitalization, beside if age is the only positive
ICU, mortality of 22%
Regardless of PSI and CURB 65, if the patient has __ or __, than __ is indicated.
septic shock
respiratory failure
ICU
The main RF for antibiotic resistant pneumococcal infection is using ___ in the last __ months
specific Abx
3
For severe CAP __ reduce mortality
macrolides
CAP + ICU = __ against __, __ such as __+__
wide spectrum Abx
pneumococcal and atypical
azithromycin
ceftriaxone
If the pathogen is immune to macrolides, use __. If that does not work- use __/ __+__
doxycycline
fluoroquinolone
beta lactam + macrolide
__is better than ceftriaxone for empiric treatment for CAP
ceftaroline
For pneumococcal pneumonia use __ + __/__
beta lactam (ceftriaxone)
macrolide (azithromycin/clarithromycin)
quinolone
When a CAP patient is stable- use __ __. If the pneumonia is uncomplicated, treat for __ days
oral
fluoroquinolone
5
What are the correct supportive care treatment for pneumonia? What will you add in severe CAP
hydration oxygen vasopressors ventilation prednisone
If CAP patients do not respond to treatment within the first _ days, we can call it __ and should __
3
treatment failure
reevaluate
In aspiration pneumonia __ should be added if __ is found
clindamycin
abscess
The imaging typical for pneumonia may endure for - weeks
4-12
Primary prevention of pneumonia is with __
PCV13 (Prevenar)
CAP treated in the community should be given __ or __ if the patient is otherwise healthy and did not use Abx in the last __ months
macrolide
doxycycline
3
CAP treated in the community should be given __ or __ or __ if the patient is has comorbidities / used Abx in the last __ months
fluoroquinolone (moxifloxacin/gemifloxacin/levofloxacin) beta lactam (amoxicillin/ augmentin) ceftriaxone, cefuroxime + macrolide/doxycycline
CAP patients requiring hospitalization should be treated with __ or __+__
fluoroquinolone (moxifloxacin/gemifloxacin/levofloxacin)
beta lactam (ceftriaxone/ampicillin/ertapenem)
macrolide
CAP patients requiring ICU should be treated with __ + __or__
beta lactam (ceftriaxone/ampicillin/ertapenem)
azithromycin
fluoroquinolone (moxifloxacin/gemifloxacin/levofloxacin)
If we suspect CAP due to pseudomonas treat with __+__
beta lactam (piperacillin/cefepime/tazobactam/meropenem/imipenem) fluoroquinolone (ciprofloxacin/levofloxacin)
If we suspect CAP due to CA-MRSA treat with __ or __ +__
vancomycin
linezolid
clindamycin
The main RF for VAP is __
endotracheal tube
In VAP, the more __ the sample is, the ,more __ it is. Other factors that can increase diagnosis are: 4
distal specific G stain CBC intracellular stain local proteins
Empirical Abx treatment for HAP/VAP patients with no RF for resistant G (-) pathogens includes: __/__/__
piperacillin
cefepime
levofloxacin
Empirical Abx treatment for HAP/VAP patients with resistant G (-) pathogens includes: 5 + 4
piperacillin/cefepime/ceftazidime/imipenem/meropenem
amikacin/gentamicin/ciprofloxacin/levofloxacin
If VAP/HAP patient has a risk factor for MRSA add __/__
linezolid
vancomycin adjusted dose
In VAP/HAP patients, treatment course of - days has the same effectiveness of _ weeks course, while leading to less resistant strains
7-8
2
The best way to avoid VAP is to avoid placing __. Other ways include: 3
endotracheal tube short term Abx prophylaxis raising the head of the bed to 30 degrees preventing gastric pH increase hygiene
