CAP pneumonia

Question 1

Acute infection of the pulmonary parenchyma must have TWO of the following symptoms:

Answer 1

Increased or decreased temp
Diaphoresis
Chills
Cough
Change in sputum color
Pleuritic chest pain
Dyspnea

Question 2

What are common pathogens of CAP?

Answer 2

Strep pneumonia (+) 20-60%
H. Influenza (-) 10-15%
Mycoplasma PNA. Atypical 10-15%
Viral 10-15%
Aspiration PNA 6-10%
Chlymidia PNA (-)5-10%
Staph aureus (+) 3-5%
Legionella (-) 2-8%

Question 3

What is lobar PNA?

Answer 3

In one lobe

Question 4

What is bronchopneumonia?

Answer 4

Patchy distributions involving more than one lobe.

Question 5

If patient is healthy and has CAP and has not had any ABX in the last 3 months what would you treat with?

Answer 5

A macrolide (azithromycin, clarithromycin, or erythromycin)

Or

Doxycycline

Question 6

If you have a healthy patient with CAP who recently had ABX treatment within the last 3 months what would you prescribe?

Answer 6

A respiratory fluroquinolone (levofloxacin)

Or

Beta lactam PLUS a macrolide

Question 7

If patient has CAP and a comborbidity what would your prescribe?

Answer 7

A beta lactam + macrolide

OR

A respiratory fluroquinolone

Question 8

If patient is in a medical ward and has no recent ABX use and has CAP what would you order?

Answer 8

Respiratory fluroquinolone

Or

Advanced macrolide azithromycin
+ B-lactam (ceftriaxone)

If recently treated with ABX in last 3 months than choose a different ABX

Question 9

An ICU patient with CAP w/o pseudomonas suspicion should be treated with what?

Answer 9

B-Lactam + fluroquinolone

OR

Azithromycin

If beta lactam allergy then:
Respiratory fluroquinolone and Azetreonam

Question 10

If Patient has pseudomonas respiratory CAP the. What would you test with?

What if they have MRSA?

Answer 10

Zosyn or cefepime or meropenum + levofloxacin or cipeofloxacin

For MRSA

Add vancomycin or linezolid

Question 11

When is pneumonia considered HAP?

Answer 11

Occurs 48 hours or more after admission without evidence of PNA prior.

Question 12

What are risk factors for multi-drug resistant pathogens?

Answer 12

Antimicrobial treatment within the last 90 days

Current hospitalization or recent hospitalization

Antibiotic resistant organisms in unit

Nursing home or extended care facility

Home infusion therapy

Dialysis patient

Home wound care

Immunosupression

Family member with MDRP