cap Flashcards
most common etioplogy of cap
patients admitted in the ICU the most common aetiologies were S. pneumoniae (62%),
atypical pathogens (14%)
and polymicrobial aetiologies (11%).
The most frequent polymicrobial pattern was S. pneumoniae and viral infection, particularly influenza virus
how has the microbial pattern changed over time
decreased incidence of atypical organisms
what are the risk factors for community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA),
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participating in contact sport, living in crowded or unsanitary conditions, intravenous drug abuse, and male homosexuality.
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what is the yield of microbial diagnosis in copd
However, the responsible pathogen is not isolated in up to 50% to 60% of patients with severe CAP
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what specific culture should be asked for where Legionella is endemic, as well as in patients with a recent travel history
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buffered charcoal yeast extract agar
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role of immunological tests in pneumonia diagnosis for s.pneumoniae
The S. pneumoniae urinary antigen test in adults has a sensitivity of 65–100% and a specificity of 94%. This test should also be considered whenever a pleural fluid sample is obtained in the setting of a parapneumonic effusion
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role of immunological tests in pneumonia diagnosis for legionella
In the diagnosis of CAP caused by L. pneumophila urinary antigen detection for serotype 1 has a sensitivity of almost 80% and a specificity approaching 100%
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what are the scores to predict icu admission?which is better ?
PSI ,CURB 65
Furthermore, in comparison with PSI, the CURB-65 has been shown to outperform generic sepsis and early warning scores
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What are the icu criteria for admission ?
Major criteria ◆ Invasive mechanical ventilation. ◆ Septic Shock with the need for vasopressors. Minor criteria ◆ Respiratory rate ≥30 breaths/min. ◆ PaO2/FiO2 ≤250. ◆ Multilobar infiltrates. ◆ Confusion disorientation. ◆ Uraemia (blood urea nitrogen (BUN) level ≥20 mg/dL). ◆ Leucopenia (white blood cell count <4 × 109/L). ◆ Thrombocytopenia (platelet count <100 × 109/L). ◆ Hypothermia (core temperature <36ºC). ◆ Hypotension (SBP <90 mmHg) requiring aggressive fluid resuscitation.
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One of the major or three or more of the minor criteria would indicate ICU admission
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what other poor prognostic features shopuld be considered
hypoglycaemia and thrombocytosis
role of steroids in severe cap
The role of glucocorticoids in severe CAP is still controversial with positive [16] and negative [17] studies. Melvis et al. [18] reported dexamethasone added to antibiotic treatment can reduce length of hospital stay, but not mortality in a population of CAP hospitalized patients.
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treatment for community acquired MRSA
The recommended antibiotic treatment for this necrotizing pneumonia includes the combination of intravenous linezolid, clindamycin, and rifampicin
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treatment concers for s.pneumoniae
penicillin and macrolide resistance
penicillin resistant strep pneumoniae are often also resistant against macrolides
quinolones are effective against these organisms
most common reason of treatment unresponsiveness for the first 72 hours and after that
in the first 72 hjours it is drug resistance and then it is other complications
risk factors assosciated with legionnares disease
Transmitted via infected water, Legionnaire disease may be indistinguishable clinically from pneumococcal pneumonia, but often includes symptoms of dry cough, diarrhea or other gastrointestinal upset, or encephalopathy not explained by hypoxemia or shock.
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