Bacterial pneumonia II

Question 1

Bacteria causing HAP

Answer 1

Gram Positive staphylococci
* S. aureus
Gram Negative enterics
* K. pneumoniae
Gram Negative nonenterics
* P. aeruginosa
* H. influenzae
* M. catarrhalis

Question 2

How to know if it is HAP

Answer 2

Lower respiratory tract infection not present on admission
* Occurs > 48 hours after admission

Question 3

Risk factors for getting HAP

Answer 3

• Hospitalized > 5 days
• Hospitalized > 2 days in past 3 months
• Immunocompromised with poor functional status
• Developed pneumonia after admission to ICU
• Mechanical ventilation

Question 4

Diagnosis of HAP is based on:

Answer 4

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

Question 5

What to consider before choosing tx for HAP

Answer 5

Choice depends on local susceptibility patterns and previous antibiotic exposure (within 90 days)
* No risk factors for MDR infections

Question 5

Drugs to treat HAP

Answer 5

Ceftriaxone, IV AND
Amikacin, IV for 10 days

Question 6

Drugs to treat HAP if severe Penicillin allergy

Answer 6

Severe Penicillin Allergy
Moxifloxacin, PO/IV
AND Amikacin, IV

Question 7

Bacteria causing VAP

Answer 7

S. pneumoniae
* S. aureus
* H. influenzae

Question 8

how is VAP diagnosed

Answer 8

Diagnosis
* > 48 hours post-endotracheal intubation
* No “gold standard”
* Suspect with worsening CXR and other findings consistent with HAP

Question 9

T/F acute aspirations requireS antimicrobial tx

Answer 9

F. Acute aspirations do not require antimicrobial therapy – even if
associated with CXR infiltrate

Question 10

In what case does aspiration pneumonia need antimicrobial therapy?

Answer 10

Consider treatment with aspiration pneumonitis and persistent or
progressive signs/symptoms 48 hours after aspirating

Question 11

what drugs can be given for aspiration pneumonitis

Answer 11

• Amoxicillin/clavulanate
• Cephalosporin PLUS clindamycin or metronidazole

Question 12

5 antimicrobial stewardship principles

Answer 12

• Empiric treatment
• Obtain cultures
• Narrow treatment if warranted
• IV to PO switching
• Appropriate treatment duration

Question 13

what are the 5 considerations for changing from IV to PO?

Answer 13

-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

Question 14

List pneumonia preventative strategies (vaccination)

Answer 14

1.Pneumococcal vaccines
( 23-valent polysaccharide (PPSV23)
* 13-valent pneumococcal conjugate (PCV13)
2. Pneumococcal polysaccharide vaccine (PPSV)23
3. Pneumococcal conjugate vaccine (PCV)13

Question 15

When should you give Pneumococcal polysaccharide vaccine (PPSV)23

Answer 15

19-64 underlying comorbid conditions, smoke, immunocompromised
* All persons 65 + years of age

Question 16

When should you give Pneumococcal conjugate vaccine (PCV)13

Answer 16

• Single dose > 18 years
• High risk: sickle cell disease and HIV
• Trivalent Influenza Vaccine

Question 17

What causes Pnemocystis pneumonia?

Answer 17

Pneumocystis jiroveci (formerly carinii)

Question 18

What are the risk factors for pneumoccystis pneumonia

Answer 18

Advanced HIV

Question 19

symptoms of Pneumocystis pneumonia

Answer 19

SOB, dry cough

Question 20

Medical tx for acute pneumocycstis pneumonia

Answer 20

Acute: Cotrimoxazole (80/400mg 4 tabs), 6 hourly for 3 weeks

Question 21

Medical tx for 2ndary prophylaxis

Answer 21

Secondary prophylaxis: Cotrimoxazole (80/400mg 2 tabs), oral daily until CD4
count is >200 cells/mm3