4- CAP Flashcards
pneumonia can be characterised based on
site of acquisition
Nosocomial pneumonia includes
HAP and VAP
HCAP is no longer used but means
pneumonia in health care facilities (nursing homes, hemodialysis centers) or after recent hospitalisation
Risk factors for CAP
old age chronic comorbidities (COPD) viral respiratory tract infection impaired airway protection smoking, alcohol, opiod use
most frequent pathogens in CAP
streptococcus pneumoniae and respiratory viruses (note that in large cases, no pathogen is detected)
why is the incidence of pneumococcal pneumonia decreasing
due to pneumococcal vaccine rates
can you diagnose CAP without a chest x ray
no, there needs to be demonstration of infiltrate on chest imaging with associated symptoms
can x ray infiltrate pattern help differentiate etiology of pathogen
no
what is the next step if x ray is inconclusive
perform CT (often done in immunocompromised pts
most common scores used in CAP
pneumonia severity index (PSI/PORT score) and CURB-65
levels of severity of care in CAP
- ambulatory care
- hospital admission
- intensive care unit
scores for ambulatory care in CAP
PSI 1-2
CURB-65 0 or 1 if old
when to have hospital admission in CAP
pts with O2 sat<92% on room air, PSI>3, and CURB-65 >1
signs of sepsis, rapidly progressing illness, inability to take oral medications, cognitive or functional impairement
who needs ICU admission for CAP
respiratory failure needing mechanical ventilation, sepsis needing vasopressor support 31
dx for CAP in ambulatory setting
microbiologic testing is not needed, empiric antibiotic therapy is successfull
