6 - Pneumonia Flashcards
Pneumonia is:
An infection of the alveoli
Could be bacteria, virus, fungi, etc
Community-acquired pneumonia
Acute pulmonary infection in a patient who is NOT hospitalized or residing in a nursing home 14 days or more before presentation
Hospital-acquired pneumonia
New infection occurring 48 hrs or more after hospital admission
Ventilator-acquired pneumonia
New infection occurring 48 or more hours after starting mechanical ventilation
Healthcare-associated pneumonia:
Patients hospitalized for 2 or more days within the past 90 days
Nursing home / long term care residents
Patients receiving home IV antibiotic therapy
Dialysis patients
Patients receiving chronic wound care
Patients receiving chemotherapy
Immunocompromised patients
Productive cough?
Think bacterial
Nonproductive cough?
Think viral or atypical
MC organism for CAP?
Pneumococcus
Most patients with severe CAP who were otherwise healthy have:
S. Pneumoniae
Or
Legionella
What kind of patient may have pneumonia with more than one organism?
Nursing home patients
Drunks
HIV with low CD4 counts
Common sxs of pneumonia
Cough Fatigue Fever Dyspnea Sputum production Pleuritic CP
Rust-colored sputum?
Steptococcus pneumoniae
Purulent sputum?
Staphylococcus aureus
Currant jelly sputum?
Klebsiella pneumonia
Patchy infiltrates with frequent abscess formation?
Pseudomonas aeruginosa
Recently hospitalized
Immunocompromised
Hot tubs
Gradual onset pneumonia?
Haemophilus influenzae
Pneumonia type more common in COPD’ers?
Moraxella catarrhalis
Gradual onset with putrid sputum?
Anaerobes
Think drunks
Slide 13-14
More detail on species-specific sxs
Classic presentation of pneumococcal pneumonia?
Sudden onset Rigors Bloody sputum High fever CP Lobar infiltrates
At risk for pneumococcal pneumonia?
Elderly Kids under 2yrs Minorities Children who attend day-care Immunosuppressed
Consider s. aureus pneumonia in what kind of patients?
Chronic lung dz Laryngeal CA Immunosuppressed NH patients Others at risk for aspiration pneumonia
How will staphylococcal pneumonia look on CXR?
Extensive infiltration and effusion or empyema
Staph vs klebsiella?
Staph insidious
Klebsiella rapid onset
Describe pseudomonas pneumonia
Severe - cyanosis, confusion
Bilateral lower-lobe infiltrates with occasional empyema
Think prolonged hospitalization, nursing homes, steroid therapy, broad spectrum ABX use
The atypical bacteria are:
Legionella, chlamydia, mycoplasma
They lack a cell wall, so they do NOT respond to beta-lactam ABX
They DO respond to macrolides OR a respiratory fluoroquinolone (levo, moxi)
At risk for legionella?
Smokers
Chronic lung dz
Transplant patients
Immunosuppressed
Legionella pneumonia is commonly complicated by:
GI sxs, including ABD pain, vomiting, and diarrhea
Mycoplasma pneumonia is frequently associated with:
Retrosternal chest pain
Also, unlike legionella, mycoplasma does NOT have GI symptoms
What extrapulmonary sxs can mycoplasma show?
Rash Neuro Arthralgia Heme Kidney
MC cause of viral pneumonia?
Influenza
If your clinical findings suggest pneumonia but our CXR is neg:
Treat empirically anyway
In the suspected pneumonia patient, an SpO2 < 91 is associated with:
More complications, and may warrant treatment beyond meds and discharge
MCC of acquired immunodeficiency syndrome-related death in pregnant women in the United States?
Pneumocystis jiroveci pneumonia
Common atypical pneumonia agent in the elderly?
Legionella
MCC of bacterial pneumonia in patients with HIV?
S. Pneumoniae
Common first choice for outpatient txt for CAP?
Single-drug therapy
Marcolide or a respiratory fluoroquinoline
Doxy as an alternative
Erythromycin is cost-effective but causes GI side effects in 25% of patients
Clarithromycin - metallic taste
Azithromycin - once daily dosing = better compliance
CDC recommendations re: use of fluoroquinolones:
Reserved for pts who cannot tolerate other agents
Or
Have documented pneumococcal resistance
Or
Have failed other therapies
Don’t use fluoroquinolones in patients with:
Myasthenia gravis
Patients admitted to the ICU with healthcare-associated pneumonia should have coverage for:
Methicillin resistant s. aureus with drugs such as vanc or linezolid
Do most patients with CAP require hospitalization?
Nope
Use the CURB-65 rule to aid in disposition decision-making
Criteria for ICU admission
Septic shock Needing a vent Markedly elevated RR Partial pressure of arterial oxygen / fraction of inspired oxygen ratio <250 Multilobar infiltrates Confusion Uremia with a BUN > 20mg/dL Leukopenia, thrombocytopenia, hypothermia, hyponatremia, lactic acidosis, asplenia
What did the homeless man get for Christmas?
Pneumonia
