B4-075 Lower Airway Infection Flashcards
hospitalized
fever, chills, fatigue
SOB
change on CXR
hospital acquired pneumonia
trachea, bronchi, lung make up the […] respiratory tract
lower
bronchitis is usually caused by [pathogen]
virus
inflammation/infection of the lung parenchyma
pneumonia
acquired > 48 into hospitalization
HAP
most common cause of aspiration pneumonia
gastric contents
usually due to malignancy
post obstructive pneumonia
no vital sign changes
self-limited
no change on CXR
usually viral
bronchitis
treatment for bronchitis
supportive care
treatment pneumonia
directed antimicrobial therapy
cause of typical CAP pneumonia
S. pneumo
cause of atypical pneumonia
3
mycoplasma
legionella
clamydia pneumo.
alveolar infiltrate
typical pneumonia
interstitial infiltrates
atypical pneumonias
nodular infiltrates
if you are admitted with pneumonia, what two tests do we want?
sputum culture
blood culture
every patient with pneumonia, rule out…
covid
flu if flu season
urinary antigen test
legionella
S. pneumo
- differentiates non-infectious from infectious pneumonia
- determine when to stop antibiotics
procalcitonin
empiric therapy for HAP and VAP
MRSA coverage
2 pseudomona drugs from different classes
- mechanical ventilation
- fever, increased oxygen requirement
- has purulent sputum
- change on CXR
VAP
what drugs should be avoided in empiric therapy of HAP and VAP?
2
- aminoglycosides
- colistin
main risk factor for resistant bugs
IV antibiotics within past 3 months
2 big drugs for MRSA
- vanc
- linezolid
antipseudomonal drugs
(B-lactams)
6
- piperacillin-tazobactam
- cefepime
- ceftazidime
- imipenem
- meropenem
- aztreonam
surfactant in the lungs inactivates
drug
daptomycin
antibiotic duration for HAP/VAP
7 days
sterile, free flowing pleural fluid adjacent to pneumonia
parapneumonic effusion
aspiration, poor dentition, malnutrition, and substance abuse can increase the risk of
complication of pneumonia
parapneumonic effusion
protracted illness
more pleuritic pain
delay in clinical improvement
complication of pneumonia
parapneumonic effusion
pleural fluid pH <7.1 or with + gram stain/culture
complication of pneumonia
empyema
treatment of empyema
drain it
alcoholism
seizures
poor oral hygiene
aspiration
risk factors for
complication of pneumonia
lung abscess
grows anaerobes on culture
complication of pneumonia
lung abscess
treatment for lung abscess
prolonged antibiotics
do not drain
intra-alveolar fibrino purulent exudate
lobar pneumonia
S. pneumo
caseating granulomas
TB
would exudate or transudate be seen in an acute infection?
exudate
why are older adults more susceptible to CAP?
aging immune system less able to respond to changes
created by inflammation from adjacent pneumonia
uncomplicated parapneumonic effusions
treatment for uncomplicated parapneumonic effusion
antibiotics for pneumonia
treatment for complicated parapneumonic effusion
antibiotics + drainage
when is a blood culture appropriate in the evaluation of CAP?
patients with prior MRSA infection
do patients with mild CAP require blood cultures?
no
COPD poses a risk for what bacterial infection?
pseudomonas
first line options for MRSA coverage
2
- vancomycin
- linezolid
first line options for gram negative coverage, including pseudomonas
specfic examples from 4 classes
- pipercillin tazobactam
- cefepime/ceftazidime
- imipenem/meropenem
- aztreonam
azithromycin with ceftriaxone would be appropriate coverage for what type of patient?
CAP with no MRSA/pseudomonas risk
- no vital sign changes
- no new findings on CXR
think…
acute bronchitis
treatment for CAP with no MRSA/pseudomonas risk
azithromycin and ceftriaxone
