CAP

Question 1

CAP Definition and MC etiologic agent

Answer 1

PNA acquired outside the hospital or long term care facility

S. pneumo (gram + alpha hemolytic)

Question 2

MCC etiologic agents for typical PNA

Answer 2

• S. pneumo
• H. influenzae
• S. aureus (select patients)
• Kelbsiella and P. aeruginosa (select patients; gram -)

Question 3

MCC etiologic agents for atypical PNA

Answer 3

• M. pneumo
• C. penumo
• Legionall
• Influenza viruses
• Adenovirus
• Metapnovirus
• RSV

Question 4

Respiratory physical exam findings in CAP

Answer 4

• Inspiratory crackles
• Bronchial breath sounds
• Dullness to percussion if lobar consolidation or parapneumonic pleural effusion present
• Tachypnea
• Hypoxia
• Cough

Question 5

If there is NO comorbidity present (associations chart), what are common etiologic agents? Typical, atypical, and viral.

Answer 5

• Typical: S. pneumo
• Atypical: C. pneumo, C. psittaci, Legionella, M. pneumo, C. burnetti
• VIral

Question 6

If there is a comorbidity present (associations chart), what are common etiologic agents?

Answer 6

• Alcoholism: S. pneumo, H. influenzae
• COPD: H. influenzae, M. catarrhalis, S. pneumo
• Post CVA: oral flora, S. penumo
• Post-obstruction of bronchi: S. penumo, anaerobes
• Post-influenza: S. pneumo or S. aureus
• Neutropenia or imminocompromised: P. aeruginosa
• IV drugs: S. aureus (MRSA/MSSA)

Question 7

NO comorbidity tx

Answer 7

This means there are no risk factors for P. aeruginosa or MRSA. Tx w/ amoxicillin or doxycycline.

Question 8

YES comorbidity risk tx

Answer 8

This means there ARE risk factors for P. aeruginosa or MRSA.

-Levofloxacin alone

OR

-Amox+clavulanate OR cerufoxime + Azithro

OR

-cefpodoxime OR clarithro

Question 9

RFs for Pseudomonas AND MRSA

Answer 9

• PRIOR ISOLATION OF EITHER ORG. ON CULTURE

- Recent hospitalization AND IV abx past 90 d

Question 10

RFs for Pseudomonas in CAP

Answer 10

1. compromised immunity
2. prior abx use
3. structural issue (CF/bronchiectasis)
4. COPD exacerbations