Bacterial pneumonia II Flashcards
Bacteria causing HAP
Gram Positive staphylococci
* S. aureus
Gram Negative enterics
* K. pneumoniae
Gram Negative nonenterics
* P. aeruginosa
* H. influenzae
* M. catarrhalis
How to know if it is HAP
Lower respiratory tract infection not present on admission
* Occurs > 48 hours after admission
Risk factors for getting HAP
- Hospitalized > 5 days
- Hospitalized > 2 days in past 3 months
- Immunocompromised with poor functional status
- Developed pneumonia after admission to ICU
- Mechanical ventilation
Diagnosis of HAP is based on:
Diagnosis based on:
* New infiltrate on CXR
* Fever
* Worsening respiratory status
* Thick secretions (neutrophil-containing)
Cultures
Collect PRIOR to initiating empiric therapy
Sputum or trachael aspirate
What to consider before choosing tx for HAP
Choice depends on local susceptibility patterns and previous antibiotic exposure (within 90 days)
* No risk factors for MDR infections
Drugs to treat HAP
Ceftriaxone, IV AND
Amikacin, IV for 10 days
Drugs to treat HAP if severe Penicillin allergy
Severe Penicillin Allergy
Moxifloxacin, PO/IV
AND Amikacin, IV
Bacteria causing VAP
S. pneumoniae
* S. aureus
* H. influenzae
how is VAP diagnosed
Diagnosis
* > 48 hours post-endotracheal intubation
* No “gold standard”
* Suspect with worsening CXR and other findings consistent with HAP
T/F acute aspirations requireS antimicrobial tx
F. Acute aspirations do not require antimicrobial therapy – even if
associated with CXR infiltrate
In what case does aspiration pneumonia need antimicrobial therapy?
Consider treatment with aspiration pneumonitis and persistent or
progressive signs/symptoms 48 hours after aspirating
what drugs can be given for aspiration pneumonitis
- Amoxicillin/clavulanate
- Cephalosporin PLUS clindamycin or metronidazole
5 antimicrobial stewardship principles
- Empiric treatment
- Obtain cultures
- Narrow treatment if warranted
- IV to PO switching
- Appropriate treatment duration
what are the 5 considerations for changing from IV to PO?
-Haemodynamically Stable (HR < 100/min) (no IV fluid need)
- Respiratory Stable (RR < 25/min) (O2 sat > 92% room air)
- Free of fever – temperature < 37.8 C
- Free of delirium
-Able to take oral medication
* Able to swallow, no vomiting, no diarrhoea
List pneumonia preventative strategies (vaccination)
1.Pneumococcal vaccines
( 23-valent polysaccharide (PPSV23)
* 13-valent pneumococcal conjugate (PCV13)
2. Pneumococcal polysaccharide vaccine (PPSV)23
3. Pneumococcal conjugate vaccine (PCV)13
When should you give Pneumococcal polysaccharide vaccine (PPSV)23
19-64 underlying comorbid conditions, smoke, immunocompromised
* All persons 65 + years of age
When should you give Pneumococcal conjugate vaccine (PCV)13
- Single dose > 18 years
- High risk: sickle cell disease and HIV
- Trivalent Influenza Vaccine
What causes Pnemocystis pneumonia?
Pneumocystis jiroveci (formerly carinii)
What are the risk factors for pneumoccystis pneumonia
Advanced HIV
symptoms of Pneumocystis pneumonia
SOB, dry cough
Medical tx for acute pneumocycstis pneumonia
Acute: Cotrimoxazole (80/400mg 4 tabs), 6 hourly for 3 weeks
Medical tx for 2ndary prophylaxis
Secondary prophylaxis: Cotrimoxazole (80/400mg 2 tabs), oral daily until CD4
count is >200 cells/mm3
