Bacterial Pneumonia

Question 1

tyes of pneumonia

Answer 1

community-acquired pneumonia

nosocomial pneumonia - hospital-acquired, ventilator-associated, and healthcare-associated

Question 2

typical symptoms of pneumonia

Answer 2

dry or productive cough

dyspnea

fever

Question 3

diagnostic findings for pneumonia

Answer 3

dullness to percussion

bronchial breath sounds

E to A changes (egophony)

CXR shows pattern distinf for pneumonia

gram stains, blood cultures, or bronchoscopic smpling are other tests

Question 4

hospital-acquired pneumonia (HAP)

Answer 4

> 48 hours after admission, not incubating at the time of admission

Question 5

ventilator-associated pneumonia (VAP)

Answer 5

> 48-72 hours after endotracheal intubation

Question 6

healthcare-associated pneumonia (HCAP)

Answer 6

hospitalized within 90 days

resident of a nursing home or long-term care facility

intravenous antibiotic therapy, chemotherapy, or wound care within 30 days

attended a hospital or hemodialysis clinic

Question 7

pathogenesis of pneumonia

Answer 7

aspiration of upper flora

inhalation of aerosolized organisms

hematogenous spread

Question 8

factors that increase risk of pneumonia

Answer 8

impaired level of consciousness

impaired cough reflex

alveolar macrophage dysfunction

Question 9

How does pneumonia develop in an intubated patient?

Answer 9

Secretions will accumulate around the inflated cuff

Leaks around the cuff will allow secretions to pass down into the lungs

Increased risk for pneumonia because there is no way for the lungs to clear

Question 10

inhaled pathogens

Answer 10

influenza

coxiella burnetii (Q fever)

anthrax

tuberculosis

aspergillosis

histoplasmosis

Question 11

hematogenous pathogens

Answer 11

tricuspid valve: S. aureus endocarditis

retropharyngeal abscess/jugular venous thrombophlebitis: Fusobacterium spp. (Lemierre’s syndrome)

Question 12

patterns of pneumonia

Answer 12

lobar pnuemonia

bronchopneumonia

interstitial pneumonia

lung abscess

Question 13

most common pathogens that cause CAP

Answer 13

streptococcus pneumoniae

Haemophilus influenzae

Mycoplasma pneumoniae

Chlamydophila pneumoniae

Legionella pneumophila

oral anaerobes, influenza virus, respiratory syncytial virus

Question 14

How does particle size affect deposition of inhaled particles?

Answer 14

large particles > 10 microns impact nose and upper airways

very small particles < 1-3 microns fail to settle out by gravity and remain suspended in the air

droplet nuclei particles 3-5 microns are deposited in the small airways and alveoli and may result in infection

Question 15

What are common pneumonias are caused by aerosols

Answer 15

influenza

tuberculosis

llegionellosis

histoplasmosis

Q fever

anthrax

Question 16

typical pneumonia

Answer 16

commonly caused by S. pneumoniae and H. influenzae

sudden onset of fever

cough productive of purulent sputum

pleuritic chest pain

signs of pulmonary consolidation

Question 17

atypical pneumonia

Answer 17

commonly caused by M. pneumoniae and C. pneumoniae

gradual onset

low grade fever

dry cough

minimal evidence of pulmonary involvement on physical exam

Question 18

clinical diagnosis of nosocomial pneumonia

Answer 18

new or progressive pulmonary infiltrates

purulent tracheobronchial secretions

fever

leukocytosis

Question 19

differential diagnosis of nosocomial pneumonia

Answer 19

fluid overload

atelectasis

pulmonary hemorrhage

pulmonary embolism

malignancy

Question 20

scoring systems to determine if a person with CAP can receive outpatient treatment

Answer 20

CURB-65 (confusion, uremia, respiratory rate, low blood pressure, age >/= 65 years)

Pneumonia Severity Index (PSI)

Question 21

management of CAP

Answer 21

empiric antibiotic therapy - respiratory fluoroquinolone (moxifloxacin or levofloxacin)

beta-lactam plus a macrolide (ceftriaxone plus azithromycin)

Question 22

management for nosocomial pneumonia

Answer 22

obtain appropriate samples

begin a combination of antibiotics to treat the most common pathogens based on local antibiograms, prior antibiotic exposure, early vs. late onset

de-escalate antibiotics based on results of clinical microbiology evaluation

Question 23

antibiotic therapy for nocosomial pneumonia

Answer 23

early-onset and no risk factors for MDR pathogens - limited spectrum antibiotic therapy

late-onset (>/= 5 days) or risk factors for MDR pathogens - broad spectrum antibiotic therapy for MDR pathogens

Question 24

risk factors for MDR pathogens

Answer 24

antimicrobial therapy within 90 days

current hospitalization of five days or more

hospitalization for more than two days within 90 days

high frequency of antibiotic resistance in the community or in the specific hostial unit

resitence in nursing home or extended care facility

home infusion therapy

chronic dialysis

home wound care

family member with multidrug-resistant pathogen or immunosuppressive disease and/or therapy

Question 25

antibiotics for MDR pathogens

Answer 25

broad spectrum

ex. meropenem or linezolid plus azithromycin

Question 26

prevention of community-acquired pneumonia

Answer 26

influenza vaccine

pneumococcal polysaccharide vaccine

pneumococcal conjugate polysaccharide vaccine

Question 27

nosocomial pneumonia prevention

Answer 27

effective infection control

avoid intubation whenever possible

semi-recumbent positioning

continuous suctioning of subglottic secretions

Question 28

treatment regimen for HAP

Answer 28

antibiotic therapy initially directed at anticipated pathogens and later tailored to organisms identified in cultures of respiratory secretions

blood or pleural fluid and supportive care

Question 29

initial antimicrobial therapy for VAP

Answer 29

selected according to the presence or absence of risk factors for infection associated with health care

initial antimicrobial regimens for someone with risk factors should appropriately treat potentially resistant pathogens including MRSA and Pseudomonas aeruginosa