Bacterial Pneumonia Flashcards
What is meant by pneumonia
Acute infection of the lung parenchyma, usually caused by bacteria
Classifications of Pneumonia
Community acquired pneumonia
Hospital acquired pneumonia
Ventilator-associated pneumonia
Aspiration pneumonia
List the symptoms of pneumonia
Fever
cough
Shortness of breath
Malaise
Chest pain
Severe: shock and respiratory failure
Symptoms of pneumonia in frail eldery
Fever and cough are often absent, new of worsening confusion, detorioration of functional status or decompensating of underlying diseases
Signs of Pneumonia
Fever (>= 38)
Crackles ore crepitations
Tachypnoea
Bronchial breath sounds
Labs: Leukocytosis, procalcitonin
List pathogone for community acquired pneumonia
S. pneumonia
S. aureus
H. Influenzae
List pathogens for Hospital acquired pneumonia
Staphylococcus aureus
G-enterics (klebsiella pneumonia)
G-nonenterics (P. aeruginosa, H. Influenza, M. catarrhalis)
List pathogens for ventilator associated pneumonia
S. pneumonoa
S. aureus
H. Influenza
List pathogens for Aspiration Pneumonia
B. Melaninigenicus’Fusobacteria
Anaerobic streptococci
Polymicrobial infections with s. aureus, s. pneumonia gram negative bacilli
List pathogens for pneumocystis jiroveci pneumonia
P. jiroveci
Mycobacterium M. Tuberculosis
List the pathogens for community acquired pneumonia
In details
Gram Positive streptococci
* S. pneumoniae (pneumococcal pneumonia)
Gram Positive staphylococci
* S. aureus
Gram Negative found in GI tract (enterics)
* Legionella, Mycoplasma & Chlamydia (atypical pneumonia)
* H. influenzae (COPD)
Factors for determining the severity of community-acquired pneumonia
CURB-65
Confusion
Urea>7 mmol/L
Respiratory rate>30 breaths/min
Low blood pressure (SBP<90/DBP<60)
Age>65 yr
CRB-65
CRB-65 WITH NO UREA
CURB-65 SCORE LESS THAN OR EQUAL TO 1, TREATMENT SETTING?
Home
CURB-65 SCORE OF 2, TREATMENT SETTING?
HOSPITAL
CURB-65 SCORE GREATER OR EQUALS TO 3, TREATMENT SETTING?
Urgent admission to hospital ICU
List the CAP treatment considerations
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
CAP TREATMENT FOR OUTPATIENT LIST IT IN DETAILS
PO
<65 yrs or no antibioyics within 90 days
1. Amoxicillin
>65 yrs or antibiotics withini 90 days or comorbidity
1. Co-amoxiclav or 2nd gen cephalosporin
Alternatives: Moxifloxacin or levofloxacin
CAP treatment for Inpatient (non-severe)
in details
PO/IV
<65 yrs or no antibiotics within 90 days
Ampicillin
>65 yrs or antibiotics within 90 days or comorbidity
Co-amoxiclav or 3rd gen cephalosporin
Alternatives: Moxifloxacin or levofloxacin
Treatment for CAP for inpatient (Severe/ICU)
Indetails
Alternatives:
Moxifloxacin or
levofloxacin
PLUS cefuroxime
OR 3rd gen cephalosporin
Co-amoxiclav
OR cefuroxime
OR 3rd gen cephalosporin
PLUS macrolide/azalide
IV
CAP adjuvant treatmnet:
Addition of which drug will better outcomes in severe CAP requiring ICU adminission
Addition pf macrolide (Azithromycin)
Under CAP adjuvant treatment:
Systemic corticosteroids:
- Severe CAP requiring ICU admission
- Methylprednisone 0.5 mg/kh/12 h or equivalent
- Not of influenza or TB is likely pr history of GI bleeding in past 90 days
How is the CAP treatment monitored?
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
which bacterial leads to CAP in children
Non-typical H. Influenza and S. aureus leading bacterial causes of severe pneumonia in children
Which respirator viruses causes CAP in children
Leading cause of pneumonia in young children is Respiratpry syncytial virus (RSV) 18 to 31% pneumonia episodes
Which opportunistic organisms causes CAP in children
PJP and cytomegalovirus (CMV)
Atypicals
CAP in children- severity
Rapid breathing: list those values
Rapid Breathing
* Infant birth – 2 mo > 60 breaths/min
* Infant 2 mo – 1 yr > 50 breaths/min
* Children 1-5 yr > 40 breaths/min
CAP in children- severity
Danger signs
Danger Signs
* O2 sat < 90% room air
* Cyanosis
* Inability to drink
* < 2 mo
* Impaired consciousness
* Grunting
CAP in children general measurements
Ensure adequate hydration
Continue feeding
Alternatives for CAP in children if they have penicillin allergy?
Azithromycin oral
Macrolides
Explain the use of Ceftriaxone use in neonates for CAP
- ONLY used in seriously ill neonates, even if jaundiced
- DO NOT administer if Ca containing IV infusion being given (< 28 days
of age) - After 28 days of age, may be given sequentially
