Bacterial pneumonia

Question 1

What are the different classifications of pneumonia

Answer 1

CAP: community-acquired
pneumonia
* HAP: hospital-acquired
pneumonia
* VAP: ventilator-associated
pneumonia
* Aspiration pneumonia

Question 2

Predisposing conditions to pneumonia

Answer 2

Very young or old age
* Other concomitant disease
* Malnutrition
* HIV infection

Question 3

Management of pneumonia is guided by:

Answer 3

Age
* Co-morbidities
* Severity of pneumonia

Question 4

Symptoms of pneumonia

Answer 4

Fever
* Cough (becomes productive and discoloured)
* Shortness of breath
* Malaise
* Chest pain
* Severe: shock and respiratory failure

Question 5

How are symptoms different in the frail elderly

Answer 5

fever and cough are often absent, new of worsening
confusion, deterioration of functional status or decompensating of
underlying diseases

Question 6

Signs of pneumonia

Answer 6

Fever (≥38⁰C)
* Crackles or crepitations
* Tachypnoea
* Bronchial breath sounds
* Labs: leukocytosis, procalcitonin

Question 7

Bacteria responsible for CAP (10)

Answer 7

S. pneumoniae
S. aureus
Atypicals
(Legionella
pneumoniae,
Mycoplasma
pneumoniae,
Chlamydia
pneumoniae)
H. influenzae

Question 8

bacteria responsible for HAP

Answer 8

Staphylococcus
aureus
G- enterics
(Klebsiella
pneumoniae)
G- nonenterics
(P. aeruginosa,
H. influenzae
M. catarrhalis)

Question 9

bacteria responsible for VAP

Answer 9

S. pneumoniae
S. aureus
Haemophilus
influenzae

Question 10

bacteria responsible for Aspiration pneumonia

Answer 10

B. Melaninogenicus
Fusobacteria
anaerobic streptococci
Polymicrobial infections
with
S. aureus,
S. pneumoniae
gram-negative bacilli

Question 11

Bacteria causing PJP (OPPORTUNISTIC INFECTION-FUNGAL INFECTION)

Answer 11

P. jiroveci
Mycobacterium
M. tuberculosis

Question 12

G+ BACTERIA CAUSING CAP

Answer 12

Gram Positive streptococci
* S. pneumoniae (pneumococcal pneumonia)
Gram Positive staphylococci
* S. aureus

Question 13

G- bacteria causing CAP

Answer 13

Gram Negative found in GI tract (enterics)

Question 14

Atypical pneumonia-causing bacteria

Answer 14

Legionella, Mycoplasma & Chlamydia (atypical pneumonia)

Question 15

In COPD pts, what usually causes pneumonia

Answer 15

• H. influenzae (COPD)

Question 16

Explain the CURB scoring for assessing severity of CAP

Answer 16

• Confusion
• Urea > 7mmol/L
• Respiratory rate > 30 breaths/min
• Low Blood Pressure (SBP <90/DBP<60)
• Age > 65 yr
  CRB-65
• CURB-65 with no Urea

Question 17

what are the treatment considerations for CAP

Answer 17

Setting
* Age (65 years)
* Antibiotic use in past 90 days
* Drug intolerance/allergy
* Comorbidities
* Alcoholism / chronic liver disease
* Cardiovascular disease / cardiac failure
* Chronic kidney disease
* COPD
* Diabetes mellitus
* HIV

Question 18

If a patient scores </= 1, what tx setting would you use

Answer 18

Home

Question 19

If a patient scores 2, what tx setting would you use

Answer 19

hospital

Question 20

If a patient scores >/=3, what tx setting would you use

Answer 20

Hospital admission to ICU

Question 21

drug tx for outpatients if <65 and no antibiotic tx in the past 90 days

Answer 21

Amoxicillin PO

Question 22

drug tx for outpatients if >65 and antibiotic tx in the past 90 days

give alternatives as well

Answer 22

co-amoxiclav or 2nd gen cephalosporin PO

Moxifloxacin or
levofloxacin

Question 23

drug tx for inpatients if <65 and no antibiotic tx in the past 90 days

Answer 23

Ampicillin PO/IV

Question 24

drug tx for inpatients if >65 and antibiotic tx in the past 90 days

GIVE ALTERNATIVE

Answer 24

Co-amoxiclav
OR cefuroxime
OR 3rd gen cephalosporin

Moxifloxacin, levofloxacin

Question 25

drug tx for ICU pts if <65 and no antibiotic tx in the past 90 days

Answer 25

Co-amoxiclav
OR cefuroxime
OR 3rd gen cephalosporin
PLUS macrolide/azalide

IV

Question 26

drug tx forICU patients if >65 and antibiotic tx in the past 90 days

GIVE ALTERNATIVES

Answer 26

Co-amoxiclav
OR cefuroxime
OR 3
rd
gen cephalosporin
PLUS macrolide/azalide

Moxifloxacin or
levofloxacin
PLUS cefuroxime
OR 3
rd
gen cephalosporin

Question 27

CAP adjuvant tx used to increase outcomes of SEVER CAP requiring ICU admission

Answer 27

Addition of macrolide (azithromycin)
* Better outcomes in severe CAP requiring ICU admission

Systemic corticosteroids
* Severe CAP requiring ICU admission
* Methylprednisone 0.5 mg/kg/12 h or equivalent
* Not if influenza or TB is likely, or history of GI bleeding in past 90 days

Question 28

How do you monitor CAP tx?

Answer 28

Review culture results and sensitivity
Decrease
* Temperature ( over 8-24 hours)
* WBC
* s/sx of infection
Increased appetite- functional GI tract
Improved Chest X-ray

Question 29

Bacterial causes of CAP in children

Answer 29

Non-typical H. influenza & S. aureus leading bacterial causes of severe pneumonia in children

Question 30

Viral causes of CAP in children

Answer 30

Respiratory viruses
* Leading cause of pneumonia in young children Respiratory syncytial
virus (RSV) 18 to 31% of pneumonia episodes

Question 31

opportunistic organisms causing CAP in children

Answer 31

Opportunistic organisms
* PJP & cytomegalovirus (CMV)
* Atypicals

Question 32

how to identify pneumonia severity in children

Answer 32

Rapid Breathing
* Infant birth – 2 mo > 60 breaths/min
* Infant 2 mo– 1 yr> 50 breaths/min
* Children 1-5 yr > 40 breaths/min

Question 33

danger signs when a peads pt has severe pneumonia

Answer 33

Danger Signs
* O2 sat < 90% room air
* Cyanosis
* Inability to drink
* < 2 mo
* Impaired consciousness
* Grunting

Question 34

Management and Tx of sever pneumonia in children

Answer 34

Ensure adequate hydration
Continue feeding
Penicillin Allergy: Macrolide - Azithromycin, oral
Ceftriaxone

Question 35

cautions for ceftriaxone usage in children

Answer 35

Ceftriaxone use in neonates
* ONLY used in seriously ill neonates, even if jaundiced
* DONOT administer if Ca containing IV infusion being given (< 28 days
of age)
* After 28 days of age, may be given sequentiall