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KC Pulmonary Module > #8: Pulmonary Infx > Flashcards

#8: Pulmonary Infx Flashcards

1
Q

A CAP dx occurs within 48 hours of admission to the hospital, in a patient who has not: (3)

A
  1. Been hospitalized >2 days in the last 90 days
  2. Had significant health care contact, including HD, wound care, chemo or IV ABX
  3. Has not resided >14 days in an extended care facility (ECF, SNF)
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2
Q

PNA and MC’s on death: (3)

A
  • 6 leading cause of death in the US
  • 2 MC cause of hospital acquired infx
  • 1 cause of nosocomial infx death
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3
Q

PNA classification system: (4)

A

1- causative pathogenic organism
2- anatomic/radiologic location
3- process of acquisition
4- by setting in which they occur

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4
Q

The major reason to classify pneumonias is:

A

to direct antibiotic therapy- and specifically to determine the risk of exposure to MDR organisms

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5
Q

Risk of MDR Pathogens: (6) RIFF95

A

RIFF95
1- RF’s for HCAP
2- IS (dz/tx)
3- Family member w/ MDR pathogen
4- Frequency of abx resistance increasing in community
5- in last 90 days, pt recieved abx for infx
6- >/=5 days: current hospitalization

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6
Q

Atypical organisms of CAP include: (5)

A

1- Mycoplasma pneumoniae
2- Legionella species
3- Chlamydophila psittaci aka parrot fever
4- Chlamydophila pneumoniae aka walking PNA
4- Chlamydophilia trachomatis: STI and PNA in infants

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7
Q

Typical Gram Positive Pathogens: (2)

A

1- Streptococcal pneumoniae

2- S. aureus

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8
Q

Typical Gram Negative Pathogens: (4 major and 4 minor)

A 
1- H. influenzae
2- Moraxella catarrhalis
3- Klebsiella pneumoniae
4- Pseudomonas aeruginosa
5- Gram-negative bacilli: uncommon *EEPS
-- e.coli
-- enterobacter spp.
-- proteus spp.
-- serratia spp.
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9
Q

Uncommon CAP etiologies: (4)

A

1- Francisella tularemia: Rabbit fever
2- Coxiella burnetti: Q fever
3- Bacillus anthracis (anthrax)
4- Yersinia pestis (plague)

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10
Q

List and compare the two forms of Legionella Dz:

A

1- Pontiac fever: virus-like presentation with malaise, fevers and HA; relatively benign
2- Frank Legionella PNA: very aggressive w/ high mortality rate

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11
Q

Describe the classic CAP presentation associated w/ PCP:

A
  • sudden onset of rigors w/ pleuritic CP in young pts
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12
Q

Describe the classic CAP sxs presentation associated w/ Legionella PNA: (4)

A

1- AMS
2- hyponatremia
3- diarrhea
4- other GI symptoms

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13
Q

Turkeys, chickens, ducks, and birds are vectors for this pathogen:

A

Chlamydophilia psittaci (Parrot fever)

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14
Q

Rabbits and rodents are vectors for this pathogen:

A

Francisella tularemia (Rabbit fever) and Yersinia pestis (Bubonic plague)

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15
Q

Cats, cattle, sheep, and goats are vectors for this pathogen:

A

Bacillus anthracis (anthrax) and Coxiella burnetti (Q fever)

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16
Q

Associated w/ exposures to overcrowded conditions such as jails, homeless shelters, dormitories: (4)

A

1- S. pneumoniae
2- Chlamydiophilia species
2- Mycoplasma species
4- Mycobacterium (TB)

17
Q

Associated w/ exposures to contaminated air conditioning or water systems: (1)

A

Legionella species

18
Q

Red “current jelly” sputum associated w/: (1)

A

Klebsiella pneumoniae PNA

19
Q

Rust colored sputum associated w/: (1)

A

S. pneumoniae PNA

20
Q

Green sputum associated w/: (3)

A

1- H. influenzae
2- Pseudomonas aeruginosa
3- S. pneumoniae PNA

21
Q

Foul smelling or bad-tasting sputum associated w/: (1)

A

anaerobic infx

22
Q

List the different factors that will influence the decision to hospitalize w/ CAP tx:

  • Comorbidities: (4)
  • PE findings: (6)
  • Labs: (4)
  • Imaging: (2)
A 
Comorbidities: (4)
1- immunocompromised state
2- hx of CHF
3- hx of CAD 
4- hx of CVA
PE findings: (6)
1- HoTN
2- tachycardia
3- tachypnea
4- AMS
5- fever
6- hypothermia
Labs: (4)
1- uncontrolled diabetes
2- hypoxia  
3- dehydration
4- hyponatremia
Imaging: (2)
1- pleural effusion
2- extent of lung involvement
23
Q

Describe CURB-65 and it’s scoring system in making the Decision to Hospitalize:

A
  • Confusion (based upon a specific mental test or disorientation to person, place, time)
  • Urea (blood urea nitrogen >20 mg/dL)
  • Respiratory rate >30 breaths/minute
  • Blood pressure [BP] (systolic <90 mmHg or diastolic <60 mmHg) aka severe HoTN
  • Age >65years
  • *1= outpatient, 2-3=inpt ward, 3+= inpt, ICU
24
Q

What is a PORT/ PSI score?

A
  • pneumonia severity index

- a more comprehensive scoring system than CURB-65 that allows clinicians to risk stratify pts needing hospitalization

25
Q

IDSA/ATS Minor Criteria for Severe CAP: (11)

A

1- Respirations > 30/ min
2- Hypoxia
3- Need for non-invasive ventilatory support (BiPAP or CPAP)
4- Multilobar infiltrates
5- Uremia (BUN>20mg/dL)
6- Leukopenia (<4K)
7- Thrombocytopenia (<100K)
8- Hypothermia
9- HoTN rq. aggressive fluid resuscitation
10- Confusion/disorientation
11- Major criteria are septic shock and mechanical ventilation

26
Q

Empiric outpt. tx of CAP in healthy pts without a prior ABX exposure in the last 90 days: (1+2 or 1)

A 
1- Macrolide- preferred
- Azithromycin (Zithromax)
- Clarithromycin (Biaxin)
OR
2- Doxycycline
27
Q

Significant comorbidities prompting quinolone OR beta lactam/macrolide use in empiric tx for CAP: (9)

A 
1- alcoholism
2- CKD
3- Chronic lung dz
4- CHD
5- Chronic liver dz
6- uncontrolled DM
7- malignancy
8- recent macrolide use in previous 90 days
9- immunocompromised pts.
28
Q

CAP tx for pts w/ a chronic dz (lung, heart, liver, or kidneys), poorly controlled DM, immunosuppression, malignancy, alcoholism, or pts who have used a macrolide in the last 90 days: (1+2 or 2+5+3)

A

1- fluoroquinolone:

  • Levofloxacin (Levaquin)
  • Moxifloxacin (Avelox)
2- beta lactam AND a macrolide:
---1) high dose amoxicillin
---2) amox-clav (augmentin)**preferred
---3)ceftriaxone
---4) cefuroxime
---5) cefpodoxime
AND
- Azithromycin (Zithromax)
- Clarithromycin (Biaxin)
 OR
- Doxycycline
29
Q

Inpt. CAP tx for general medical ward/telemetry and ICU pts. w/o Pseudomonas or Legionella RF’s: (1+2 or 1+2)

A

1- Beta lactam with a macrolide (preferred)
—1) Ceftriaxone (Rocephin) 1-2 gram daily IVPB
—2) Cefotaxime (Claforan) 1-2 gm IVPB q 8
with Azithromycin (Zithromax) 500mg IVPB daily
OR
2- fluoroquinolone:
—1) Moxifloxicin (Avelox) 500mg IV daily
—2) Levofloxacin (Levaquin) 750mg dose IV daily

30
Q

Inpt. CAP tx for ICU pts. w/ Pseudomonas or Legionella RF’s: (7)

A 
1- Piperacillin-tazobactam (Zosyn) 4.5gm IV q6
2- Imipenem (Primaxin) 500mg IV q 6hrs
3- Meropenem (Merrem) 1gm IV q 8hrs
4- Cefepime (Maxipeme) 2gms IV q 8hrs
5- Ceftazidime (Fortaz) 2 gm IV q 8hrs
*PLUS, if double coverage needed:
6- Ciprofloxacin 400mg IV or 500mg po q 8 hrs
7- Levofloxacin 750mg IV or po QD
31
Q

Empiric tx for CAP-MRSA with Vancomycin should be given to hospital pts with severe CAP, defined as: (5 major and 6 minor)

A 
1- Admission to the ICU for septic shock or mechanical ventilation 
2- Necrotizing or cavitary infiltrates
3- Empyema
4- GPC in clusters on sputum gram stain
5- Risk factors for cap-MRSA: 
--- 1- ESRD
--- 2- IVDA
--- 3- MSM
--- 4- prisoners
--- 5- recent influenza-like illness
--- 6- recent ABX therapy (particularly with quinalone) in last 3 months
32
Q

Vaccines recommended in prevention of CAP: (4)

A 
1- Seasonal influenza vaccine
- IM: killed virus
- Nasal spray: attenuated virus
2- PCP
3- Pneumococcal conjugate vaccine
4- Pneumococcal polysaccharide vaccine
33
Q

Tx of HAP/VAP w/ early and less severe infx can be tx empirically with the following: (3)

A

1- 3rd gen cephalosporins
2- Beta lactam/BLI
3- Respiratory fluoroquinalone

34
Q

Tx of HAP/VAP w/ early and less severe infx likely does not cover these organisms:

A
  • pseudomonas

- mrsa

35
Q

Tx of HAP/VAP w/ more severe HAP or VAP rqs. broader abx coverage for 7 days, which includes: (2+3)

A

*An aminoglycoside or fluoroquinolone, plus one of the following:
1- An anti-pseudomonal penicillin (Zosyn)
2- An anti-pseudomonal cephalosporin (Cefepime)
3- A carbapenem

36
Q

Parenteral tx for aspiration PNA: (1)

A

ampicillin-sulbactam (unasyn)

37
Q

Tx for aspiration PNA in a pt who is not severely ill: (3)

A

1- amox-clav (augmentin)
2- metronidazole AND PCN G
3- metronidazole AND amoxicillin

38
Q

Tx for aspiration PNA in a pt who is allergic to PCN:

A

1- metronidazole AND cefotaxime (preferred)
2- metronidazole AND ceftriaxone (preferred)
3- clindamycin: may cause C. diff

39
Q

Lung abscess tx: (4)

A 
* likely rq. IV abx initially and abx continued for 3+ wks- and ID consult
1- ampicillin-sulbactam (unasyn)
2- meropenem (merrem)
3- carbapenem-imipenem (primaxin)
4- PO augmentin

KC Pulmonary Module (18 decks)

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