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Pneumonia > Bugs/Drugs > Flashcards

Bugs/Drugs Flashcards

1
Q

Name as many signs/sx of CAP as you can.

A 
Fever/hypothermia
Tachypnea
Cough +/- sputum
dyspnea
chest discomfort
sweats and or rigors
tachypnea
tachycardia
O2 desaturation
pleurisy
hemoptysis
fatigue
Headache
anorexia
abdomen pain
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2
Q

Possible physical exam findings for CAP

A

Bronchial breath sounds, inspiratory crackles, dullness to percussion.

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3
Q

CXR findings for CAP

A

any of the following are possible:
Parenchymal opacity
patchy airspace opacities
lobar consolidation with air bronchograms
diffuse alveolar and interstitial opacities

CXR or CT required to establish diagnosis!

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4
Q

What is the best way to treat CAP

A

EMPIRICALLY - don’t wait for labs to come back, promptly initiate a drug, ideally one that the bug is susceptible to

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5
Q

When is diagnostic testing indicated?

A

Generally not, unless there is something funky in the history to make you suspect an atypical pneumonia or some other cause.

Diagnostic tests include sputum gram stain, urinary antigen tests (for S. pneumonia and legionella), and rapid antigen (influenza).

Patients who require hospitalization will require 2+ blood draws for culture from at least two sites.

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6
Q

How big a problem is CAP?

A

4-5 million cases per year, 25% of which require hospitalization.

Most deadly infectious disease, 8th leading cause of death!

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7
Q

What are the risk factors for CAP?

A 
Advanced age
Alcoholism
Tobacco Use
Comorbid Medical Conditions
Immunosupression
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8
Q

Where/when does CAP occur?

A

Outside of the hospital/health care setting, or within 48 hours of admission.

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9
Q

What are two preventative measures for CAP?

A

Pneumococcal vaccine, flu shot

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10
Q

Empiric treatment for an outpatient CAP without recent antibiotic use?

A

Macrolide or doxy

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11
Q

Empiric treatment for an outpatient CAP with comorbid condition or recent antibiotic use?

A

Respiratory floroquinolone or macrolide + beta-lactam

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12
Q

Empiric therapy for an inpatient CAP who is NOT in the ICU

A

respiratory floroquinolone or macrolide+B-lactam

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13
Q

Empiric therapy for an inpatient CAP who IS in the ICU

A

Azithromycin or respiratory fluroquinolong +

antipneumococcal beta-lactam

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14
Q

Empiric therapy for an inpatient CAP who is in the ICU and at risk for pseudomonas?

A

Azithromycin or respiratory fluroquinolone
+antipneumococcal
+antipseudomal beta-lactam
+aminoglycoside

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15
Q

Empiric therapy for an inpatient CAP pt who is at risk for MRSA

A

Azithromycin or respiratory fluroquinolone

+vancomycin

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16
Q

How does HAP differ from CAP?

A
  1. Different infectious causes
  2. Different antibiotic susceptibility and increased resistance
  3. Patient’s underlying health status puts them more at risk
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17
Q

Risk factors for nosocomial pneumonia

A

malnutrition, advanced age, altered consciousness, swallowing disorder, underlying disease

18
Q

When does HAP occur?

A

48 hours after admission to the hospital or other health care facility, excludes any infection present at the time of admission.

19
Q

When does HCAP occur?

A

It occurs in community members whose extensive contact with healthcare has changed their risk for organisms.

20
Q

What must be present for a diagnosis of nosocomial pneumonia?

A

1) At least two of the following:
- fever
- leukocytosis
- purulent sputum
2) New or progressive opacity on CXR

21
Q

How common in nosocomial pneumonia?

A

Very common in patients requireing ICU or ventiliation.

HAP=2nd most common cause of infection and leading cause of death due to infection, with a 20-50% mortality rate

22
Q

How is nosocomial pneumonia treated?

A

EMPIRICALLY. You can always decelerate when the labs come back if necessary!

23
Q

What labs should be done for a person with suspected nosocomial pneumonia?

A
  • Blood cultures from 2 different sites
  • ABG to determine severity and need for ventilator
  • thoracentesis if a pleural effusion is present
  • sputum gram stain
24
Q

What is the treatment for nosocomial pneumonia when there is a low risk of resistance?

A

One of the following:

  • Ceftriaxone
  • Respiratory floroquinolone
  • Ampicillin-sulbactam
  • Piperacillin-tazobactam
  • Ertapenem
25
Q

What is the treatment for nosocomial pneumonia when there is a high risk of resistance?

A

ONE OF EACH:

1) Antipseudomonal (Cefipine, piperacillin)
2) 2nd antipseudomonal (levofloxacin, gentamicin)
3) Coverage for MRSA (vanco, linezolid)

26
Q

Most common causes of CAP in outpatient setting?

A
  1. S. pneumoniae (2/3!) –> Macrolide or doxy
  2. M. pneumoniae –> macrolide or doxy
  3. C. pneumoniae –> macrolide or doxy
27
Q

What are the most common causes of CAP in an ICU setting?

A
  1. S. pneumo
  2. Legionella
  3. H. flu
  4. Enterobacae
  5. S. aureus
  6. Pseudomonas

treat with azithromycin and a respiratory fluroquinolone

28
Q

What are the most common causes of CAP in a hospitalized patient?

A
  1. S. pneumoniae (respiratory fluoroquinolone -or- macrolide+beta lactam
  2. M. Pneumoniae (respiratory fluoroquinolone -or- macrolide+beta lactam
  3. C. pneumoniae ((respiratory fluoroquinolone -or- macrolide+beta lactam)
  4. H. flue (respiratory fluoroquinolone -or- macrolide+beta lactam
  5. Legionella (respiratory fluoroquinolone -or- macrolide+beta lactam
29
Q

What are the main causes of HAP?

A
  1. S. aureus (MSSA and MRSA)
  2. P. aeruginosa
  3. Gram - rods
30
Q

What are the main causes of VAP

A
  1. Much like HAP! Staph, pseudomonas, gram - rods
  2. Acinetobacer
  3. stentophomas maltophila
31
Q

What are the main causes of HCAP?

A
  1. Strep penumo
  2. H. flu
  3. Similar to HAP (staph, pseudomonas, gram - rods)
32
Q

What are the atypical pneumonas and how are they treated?

A

M. pneumonia (clarithromycin, azithromycin, doxy)
C. pneumonia (doxy)
P. jiroveci (TMP-SMX)
Legionella (?)

33
Q

Typical or atypical? Treatment? S. pneumoniae

A

Typical - amoxicillin, PCN, or cephalosporin

34
Q

Typical or atypical? Treatment? H. influenza

A

Typical - TMP-SMX

35
Q

Typical or atypical? Treatment? S. aureus

A

Typical. MSSA=nafcillin, MRSA = vanco

36
Q

K. pneumonia - Typical or atypical? Treatment?

A

Typical. Cephalosporin.

37
Q

E. coli - Typical or atypical? Treatment?

A

Typical. Cefotaxime, ceftriaxone

38
Q

P. aeruginosa - Typical or atypical? Treatment?

A

Typical. Piperacillin-tazobactam or ceftazidime or cefepime, imipenem or meropenem or doripenem +/- aminoglycosides

39
Q

M. catarrhalis - Typical or atypical? Treatment?

A

Typical. cefuroxime, fluroquinolone

40
Q

common macrolides

A

clarithromycin, azithromycin

41
Q

common beta-lactam

A

cefotaxime, ceftriaxone, ampicilli

Pneumonia (1 decks)

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