Bacterial pneumonia Flashcards
What are the different classifications of pneumonia
CAP: community-acquired
pneumonia
* HAP: hospital-acquired
pneumonia
* VAP: ventilator-associated
pneumonia
* Aspiration pneumonia
Predisposing conditions to pneumonia
Very young or old age
* Other concomitant disease
* Malnutrition
* HIV infection
Management of pneumonia is guided by:
Age
* Co-morbidities
* Severity of pneumonia
Symptoms of pneumonia
Fever
* Cough (becomes productive and discoloured)
* Shortness of breath
* Malaise
* Chest pain
* Severe: shock and respiratory failure
How are symptoms different in the frail elderly
fever and cough are often absent, new of worsening
confusion, deterioration of functional status or decompensating of
underlying diseases
Signs of pneumonia
Fever (≥38⁰C)
* Crackles or crepitations
* Tachypnoea
* Bronchial breath sounds
* Labs: leukocytosis, procalcitonin
Bacteria responsible for CAP (10)
S. pneumoniae
S. aureus
Atypicals
(Legionella
pneumoniae,
Mycoplasma
pneumoniae,
Chlamydia
pneumoniae)
H. influenzae
bacteria responsible for HAP
Staphylococcus
aureus
G- enterics
(Klebsiella
pneumoniae)
G- nonenterics
(P. aeruginosa,
H. influenzae
M. catarrhalis)
bacteria responsible for VAP
S. pneumoniae
S. aureus
Haemophilus
influenzae
bacteria responsible for Aspiration pneumonia
B. Melaninogenicus
Fusobacteria
anaerobic streptococci
Polymicrobial infections
with
S. aureus,
S. pneumoniae
gram-negative bacilli
Bacteria causing PJP (OPPORTUNISTIC INFECTION-FUNGAL INFECTION)
P. jiroveci
Mycobacterium
M. tuberculosis
G+ BACTERIA CAUSING CAP
Gram Positive streptococci
* S. pneumoniae (pneumococcal pneumonia)
Gram Positive staphylococci
* S. aureus
G- bacteria causing CAP
Gram Negative found in GI tract (enterics)
Atypical pneumonia-causing bacteria
Legionella, Mycoplasma & Chlamydia (atypical pneumonia)
In COPD pts, what usually causes pneumonia
- H. influenzae (COPD)
Explain the CURB scoring for assessing severity of CAP
- 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
what are the treatment considerations for CAP
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
If a patient scores </= 1, what tx setting would you use
Home
If a patient scores 2, what tx setting would you use
hospital
If a patient scores >/=3, what tx setting would you use
Hospital admission to ICU
drug tx for outpatients if <65 and no antibiotic tx in the past 90 days
Amoxicillin PO
drug tx for outpatients if >65 and antibiotic tx in the past 90 days
give alternatives as well
co-amoxiclav or 2nd gen cephalosporin PO
Moxifloxacin or
levofloxacin
drug tx for inpatients if <65 and no antibiotic tx in the past 90 days
Ampicillin PO/IV
drug tx for inpatients if >65 and antibiotic tx in the past 90 days
GIVE ALTERNATIVE
Co-amoxiclav
OR cefuroxime
OR 3rd gen cephalosporin
Moxifloxacin, levofloxacin
drug tx for ICU pts if <65 and no antibiotic tx in the past 90 days
Co-amoxiclav
OR cefuroxime
OR 3rd gen cephalosporin
PLUS macrolide/azalide
IV
drug tx forICU patients if >65 and antibiotic tx in the past 90 days
GIVE ALTERNATIVES
Co-amoxiclav
OR cefuroxime
OR 3
rd
gen cephalosporin
PLUS macrolide/azalide
Moxifloxacin or
levofloxacin
PLUS cefuroxime
OR 3
rd
gen cephalosporin
CAP adjuvant tx used to increase outcomes of SEVER CAP requiring ICU admission
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
How do you monitor CAP tx?
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
Bacterial causes of CAP in children
Non-typical H. influenza & S. aureus leading bacterial causes of severe pneumonia in children
Viral causes of CAP in children
Respiratory viruses
* Leading cause of pneumonia in young children Respiratory syncytial
virus (RSV) 18 to 31% of pneumonia episodes
opportunistic organisms causing CAP in children
Opportunistic organisms
* PJP & cytomegalovirus (CMV)
* Atypicals
how to identify pneumonia severity in children
Rapid Breathing
* Infant birth – 2 mo > 60 breaths/min
* Infant 2 mo– 1 yr> 50 breaths/min
* Children 1-5 yr > 40 breaths/min
danger signs when a peads pt has severe pneumonia
Danger Signs
* O2 sat < 90% room air
* Cyanosis
* Inability to drink
* < 2 mo
* Impaired consciousness
* Grunting
Management and Tx of sever pneumonia in children
Ensure adequate hydration
Continue feeding
Penicillin Allergy: Macrolide - Azithromycin, oral
Ceftriaxone
cautions for ceftriaxone usage in children
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
