CAP

Question 1

How would you classify a patient admitted to the hospital who showed symptoms of pneumonia less than 48 hours after admission?

Answer 1

CAP - Risk factors for HCAP not met.
HCAP - Pt meets certain risk factors for MDR infection like previous hospitalization within 90 days, recent antibiotic use, family member with MDR infection, etc.

Question 2

Pt has pneumonia more than 48 hours after hospital admission.

Answer 2

HAP

VAP - If used endotracheal intubation

Question 3

What has the highest mortality rate in patients?

Answer 3

VAP, HCAP, and HAP

Question 4

What is the second most common nosocomial infection?

Answer 4

HAP

Question 5

What is the most common pathogen for CAP? Gram?

Answer 5

Streptococcus pneumoniae. Gram +

Question 6

What is another common pathogen for CAP? Gram?

Answer 6

Haemophilus influenzae. Gram -.

Question 7

What are the three atypical (but still common) causes of CAP?

Answer 7

Mycoplasma, Chlamydophila, Legionella. These are atypical because they are intracellular and do not show up on a gram stain.

Question 8

If the patient has CAP and doesn’t get better, what could they have?

Answer 8

MRSA, pseudomonas, etc.

Question 9

What should you consider when you decide on treatment?

Answer 9

patient demographics (age, travel history, morbidities, travel exposure, etc.)

Question 10

What is the gold standard for diagnosis? What would less common pathogens have?

Answer 10

Chest x-ray, rarely negative. Less common pathogens would be in both lobes.

Question 11

What is PSI?

Answer 11

Pneumonia severity index (levels 1-5, level 1 being less serious. Tells if pt needs to be hospitalized).

Question 12

What is the CURB-65?

Answer 12

It is a test used to assess the risk of mortality in CAP.

Question 13

Are blood cultures helpful.

Answer 13

Not really.

Question 14

Are sputum samples helpful?

Answer 14

Unreliable, don’t wait for. Can be easily contaminated.

Question 15

Is coverage of the atypical and anaerobes justified?

Answer 15

Controversy, because they are rarely fatal.

Question 16

What can be added to cover anaerobes?

Answer 16

Clindamycin, ceftriaxone.

Question 17

Streptococcus is the most common pathogen, what are the common things that it is resistant to?

Answer 17

Beta lactams like penicillin, and macrolide. Can still use penicillin without treatment failure.

Question 18

If a person is previously healthy with no antimicrobial use for the last 3 months, what would you treat with first?

Answer 18

Macrolide first, doxycycline second.

Question 19

If a person has comorbidities or antimicrobial use within the last three months, what would you treat with first?

Answer 19

Two choices:

1. Flurouquinolone (moxifloxacin, gemifloxacin, levofloxacin).
2. Macrolide plus beta lactam (axithromycin plus penicillin)

Question 20

Inpatient, non ICU

Answer 20

2 choices:

1. Respiratory flurouquinolone (moxi/gemi/levo floxacin)
2. Macrolide and beta lactam (ceftriaxone and azithromycin)

Question 21

Inpatient, ICU

Answer 21

2 choices:

1. beta lactam + flurouquinolone
2. Beta lactam + macrolide

Question 22

If the patient is allergic to penicillin, what would you choose?

Answer 22

FLouroquinolone and aztreonam

Question 23

What do you use if patient has Strept?

Answer 23

Pen and amox, or macrolide as alternate.

Question 24

What do you use if pt has H. influ?

Answer 24

Amoxicillin, or amox/Clav