Bacterial Pneumonia Flashcards
What is the presentation for bacterial pneumonia?
Fever or hypothermia, tachypnea, cough w/ or w/o sputum, dyspnea, chest discomfort, sweat or rigors, fatigue, myalgia, pleurisy, hemoptysis, HA, anorexia, abd pain
What are the physical findings for bacterial pneumonia?
Fever, tachypnea, tachycardia, arterial oxygen desaturation, bronchial breath sounds or crackles in inspiration, dullness to percussion, CXR signs of PNA
What is empyema?
Collection of pus in the pleural cavity (between the lung and pleura)
What is a cavitation?
when normal lung tissue is replaced by a cavity
What is the MCC of PNA?
strep pneumoniae
Whats the clinical setting for strep pneumoniae infection?
follows URI, chronic cardiopulmonary disease
What are the complications for strep pneumoniae infection?
Bacteremia, meningitis, endocarditis, pericarditis, empyema
What abx is used to treat strep pneumonia?
penicillin
What is the clinical setting for H influenza?
chronic cardiopulmonary disease
What are the complications for H infleunza infection?
empyema and endocarditis
What abx is used to treat H influenzae?
Ampicillin, sulphamethoxazole and trimethoprim
What is the clinical setting for staph aureus?
Hospital associated, LTCF associated, influenza epidemics, cystic fibrosis and injection drug use
What are the complications associated with staph aureus?
Cavitation and empyema
What abx is used to treat staph aureus?
penicillin, MRSA coverage use vancomycin or teicoplanin
What is the clinical setting for Klebsiella?
Alcohol abuse, DM and hospital associated
What are the complications associated with Klebsiella?
Cavitation and empyema
What abx is used to treat Klebsiella infection?
Cephalosporins (cefotaxime and ceftriaxone) or carbapenems (imipenem or cilastatin)
What is the clinical setting and complications for E coli?
Hospital associated; empyema
What abx is used to treat E coli?
Carbapenem
What is the clinical setting and complications for pseudomonas?
Hospital associated, cystic fibrosis, bronchiectasis; cavitation
What abx is used to treat pseudomonas?
Ceftazidime, ciprofloxacin, gentamycin, imipenem, tobramycin, piperacillin tazobactam
What are the clinical settings and complications for anaerobes?
Aspiration and poor dental hygiene; necrotizing PNA, abscess, empyema
What abx are used to treat anaerobes?
Metronidazole and clindamycin
What is the clinical setting for legionella?
Summer and fall, contaminated water source, construction sites, air conditioners; CAP or HAP
What are the complications associated with legionella?
Empyema, cavitation, endocarditis, pericarditis
What abx are used to treat legionella?
fluoroquinolone or macrolide
What is the clinical setting for mycoplasma pneumonia?
Young adults in the summer and fall
What are the complications for mycoplasma pneumonia?
Skin rashes, bullous myringitis, hemolytic anemia
What abx is used to treat mycoplasma pneumonia?
doxycycline or macrolide
What is the clinical setting for chlamydophilia pneumonia?
Like m pneunomiae, buy prodrome is up to 2 weeks, sore throat, hoarseness
What complications are associated with chlamydophilia pneumonia?
Reinfection in older adults with COPD or heart failure
What abx is used to treat chlamoydophila pneumonia?
doxycycline, macrolide, fluoroquinolone
What is the clinical setting for M catarrhalis?
Pre-existing lung disease, elderly patients, corticosteroids or immunosuppressive therapy
What are the complications associated with M catarrhalis?
rarely pleural effusion and bacteremia
What abx is used to treat M catarrhalis?
amoxicillin/clavulanic acid, cefuroxime, ciprofloxin, erythromycin
What are the RF for MDR?
abx therapy in the past 90 days, septic shock, ARDS preceding VAP, >5 days inpatient before HAP/VAP, tx in a unit where >10% gram neg isolates resistant, local susceptibility rates are unknown
What are the RS for MRSA?
Abx therapy in the past 90 days, renal replacement therapy in the past 30 days, use of gastric acid suppression agents, positive culture or MRSA colonization esp in the past 90 days, hospitalization in a unit where >20% of S aureus are MRSA, hospitalizations in a unit where MRSA rates are unknown
What are the risk factors for pseudomonas and other gram negative rods?
Abx therapy in the past 90 days, structural lung disease (COPD, bronchiectasis, cystic fibrosis), recent hospitalizations (esp with manipulation of the aero digestive tract such as intubation). high quality gram stain of respiratory secretions with numerous and predominately gram neg bacilli, positive culture for P aeruginosa
What is the CURB-65 pneumonia severity score?
Confusion (used on specific mental test, new disorientation to person place or time), urea >7mmol/L (20mg/dL), respiratory rate >30, BP <90/<60, age >65
What does a CURB-65 score of 0-1 recommend?
consider treatment at home
What does a CURB-65 score of 1-2 recommend?
favor admission (unless otherwise healthy >65yo)
What does a CURB-65 score of 3-4 recommend?
Hospital admission is indicated
What does a CURB-65 score of 4-5 recommend?
Consider ICU admission
Which vaccines should be given for pneumonia prevention?
influenza (yearly), pneumococcal conjugate, pneumococcal polysaccharide, H influenza type b
