Community Acquired Pneumonia - Rupp Flashcards
Characteristic Radiographic Appearance of Right-Sided Endocarditis
focal embolic lesion
Etiology of Community Acquried Pneumonia
Bird, Tick, Rodent Exposure; Rancher
Bird Exposure: Psittacosis, Histoplasmosis
Rancher: Q-fever, Brucellosis
Tick Exposure/Hunter: Tularemia
Rodent Exposure: sin nombre virus (hanta virus)
Characteristic Radiographic Appearance of Aspiration
superior segment of right middle lobe
or
posterior segment of right upper lobe
Outpatient Management of Community Acquired Pneumonia
Previously Healthy: macrolide or doxycycline
Comorbidities: respiratory fluoroquinolone or ß-lactam + macrolide
Urinary Antigen Detection
Pneumococcal Ag: rapid, simple, not affected by antibiotic administration, may stay positive for 2-3 months
Legionella Ag: detects serogroup 1
Characteristic Radiographic Appearance of Bacterial Pneumonia
Lobar of segmental consolidation
Community Acquired Pneumonia - Discharge Criteria
no more than 1 during prior 24 hours (unless it is a baseline status):
Temperature > 37.8 C
Pulse > 100 beats/min
Respiration > 24 breaths/min
Systolic blood pressure < 90 mm Hg
Blood O2 saturation < 90%
Inability to maintain oral intake
Characteristic Radiographic Appearance of Pneumonia - “atypical” pathogen
Diffuse or patchy interstitial pattern
Characteristic Radiographic Appearance of Tuberculosis
apical infiltrates, cavitation
Etiology of Community Acquried Pneumonia
CF/Bronchiectasis, COPD, Influenza, Cough > 2-3 Weeks
CF/Bronchiectasis: Pseudomonas, Burkholderia, S. aureus
COPD: H. influenzae, M. catarrhalis
Influenza: S. aureus, infleunza
Cough > 2-3 weeks: Pertussis, TB
Prevention of Community Acquired Pneumonia
Get flu vaccine
Pneumococcal vaccine
Covering coughs
Hand washing
Etiology of Community Acquired Pneumonia
Splenectomy, HIV, IV Drug Abuse, Alcoholism
Splenectomy: encapsulate organisms - H. influenzae, Pneumococcus
HIV: Pneumococcus, PCP, TB
IV Drug Abuse: right sided endocarditis (S. aureus)
Alchoholism: Pneumococcus, Klebsiella or other g(-) bacilli aspiration
Community Acquired Pneumonia - Duration of Therapy
treat for a minimum of 5 days
should be afebrile for 48-72 hours
should have no more than 1 CAP associated sign of clinical instability
Criteria for ICU Admissions for Community Acquired Pneumonia
Major Criteria & Minor Criteria
admit to ICU with 1 major or 3 minor
Major Criteria:
- need for mechanical ventilation or pressors
Minor Criteria:
- Respiratory rate > 30/min
- PaO2/FIO2 < 250
- Multilobar infiltrates
- Altered mental status
- Uremia (BUN > 20)
- Leukopenia (
- Thrombocytopenia (
- Hypothermia (
- Hypotension requiring fluid resuscitation
Etiology of Community Acquried Pneumonia
Travel, Hotel/Cruise Ship
Travel: Coccidioidmycosis, Histoplasmosis, Melioidosis
Hotel/Cruise Ship: Legionella
Inpatient Management of Community Acquired Pneumonia
Medical Ward: respiratory fluroquinolone or ß lactam
ICU: ß-lactam + either azithromycin or a respiratory fluoroquinolone
Special Concerns - could probably look this up in Sanford : )
Pseudomonas: antipneumococcal, antipseudomonal ß-lactam + cipfrofloxacin or levofloxacin ORa ntipneumococcal, antipseudomonal ß-lactam + aminoglycoside and azithromycin
Psedomonas and Penicillin Allergy: aztreonam
CA-MRSA: add linezolid or vancomycin
Sputum Examination in Community Acquired Pneumonia
specimen should be from deep cough, purulent
immediately transported to laboratory
examine under microscope - report semiquantitatively
performed to optimize antibiotic selection
CURB-65 Scoring System
C - confusion
U - BUN level > 7 mmol/L
R - respiratory rate > 30 breaths/min
B - low blood pressure (systolic < 90 mmHg or diastolic < 60 mmHg)
65 - greater risk if over 65 years of age
