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PHRM 865 > E3 LRTI > Flashcards

E3 LRTI Flashcards

1
Q

definition of CAP

A

pneumonia that developed outside of the hospital or within the first 48 hours of hospital admission

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2
Q

3 things listed under pathogenesis for CAP, and then which one is most common

A

Aspiration **
Aerosolization
Bloodborne

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3
Q

which microorganism class is the most common pathogenic organism for CAP?
A. Fungus
B. Bacteria
C. Virus
D. Protozoa

A

C

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4
Q

most common bacterial pathogen

A

streptococcus pneumoniae

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5
Q

risk factors for drug resistance : strep pneumo

A
  • age <6 or >65
  • prior antibiotic therapy
  • comorbid conditions
  • recent hospitalization
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6
Q

“more common” atypical bacteria for CAP

A

mycoplasma pneumoniae

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7
Q

common way mycoplasma pneumo is spread

A

person to person contact

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8
Q

how is legionella pneumo spread

A

aerosolization

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9
Q

what is an important thing to consider in an infection caused by staph aereus

A

get MRSA nasal PCR test to predict value for MRSA in CAP*

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10
Q

5 conditions that serve as risk factors for many pathogens

A
  • alcoholism
  • COPD/smoker
  • post influenza pneumo
  • structural lung disease
  • recent antibiotic exposure
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11
Q

clinical presentation of CAP (5)

A
  • sudden onset of fever
  • chills
  • pleuritic chest pain
  • dyspnea
  • productive cough
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12
Q

clinical presentation of CAP:
gradual onset with lower severity for ________ and _______ pneumoniae

A

mycoplasma
chlamydia

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13
Q

clinical presentation of CAP, elderly patients:
classic symptoms may be _________ such as what 2 things

A

absent
afebrile, mild leukocytosis

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14
Q

4 vitals for clinical presentation of CAP

A
  • febrile
  • tachycardia
  • hypotensive
  • tachypnea
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15
Q

what is rec for all pts with suspicion for CAP

A

chest x ray

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16
Q

what does sputum look like:
viral:
bacterial:

A

viral -> clear
bacterial -> gross

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17
Q

when doing a microscopic exam of sputum we only evaluate samples with >__ PMNs and < 10 epithelial cells

A

25, 10

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18
Q

i dont remember what he said on slide 21 so i will go back and find that later i promise

A

thanks cole

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19
Q

what are the 2 major criteria for severe CAP? how many of these do you need to qualify it as severe

A
  • septic shock requiring vasopressors
  • respiratory failure requiring mechanical ventilation
    (only need one of these to occur for severe)
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20
Q

9 minor criteria for severe cap and how many do you need to consider it severe (i dont think we will need to know all of this but might as well throw it in here) i will star ones that came up in his cases tho frfr

A
  • resp rate >30BPM *
  • PaO2/FlO2 <250
  • multilobar infiltrates
  • confusion/disorientation *
  • uremia (BUN >20) *
  • Leukopenia (WBC <4000)
  • Thrombocytopenia (Pit <100,000)
  • Hypothermia (temp <36)
  • hypotension requiring fluids *
    NEED 3 OF THESE
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21
Q

Other tools for CAP:
procalcitonin
when is it clinically useful?

A

guiding DURATION of treatment

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22
Q

T or F:
procalcitonin is a useful tool to determine antibiotic needs for CAP

A

false *

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23
Q

what are the two clinical prediction tools for CAP and which one is common

A
  • pneumonia severity index (PSI)
  • CURB-65 *
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24
Q

what does CURB-65 do?

A

estimates mortality for CAP

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25
Q

CAP Empiric therapy, outpatient, NO comorbidities (3)

A
  • amox 1 gm PO Q8h
  • doxy 100 mg PO BID
  • macrolide resistance <25%: azithromycin
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26
Q

CAP Empiric therapy, outpatient, WITH comorbidities:
monotherapy -> ___
combo therapy -> __

A

mono: levo, moxi (respiratory FQs)
combo: B-lactam + macrolide OR doxy

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27
Q

what are the comorbidities we focus on for treatment options? (a lot)

A
  • heart disease
  • lung disease
  • renal disease
  • T2DM
  • alcoholism
  • cancer
  • asplenia/immunosuppression (wont be asked about probably)
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28
Q

3 recommended b-lactams for the combos used with outpatient CAP

A
  • amox/clav
  • cefpodoxime
  • cefuroxime
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29
Q

CAP empiric therapy, non-severe, inpatient, NO comorbidities
mono:
combo:

A

mono: levo, moxi
combo: B-lactam + macrolide

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30
Q

rec beta lactams for use in inpatient setting for combo therapy

A

amp/sulbactam (unasyn)
ceftriaxone

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31
Q

CAP empiric therapy, inpatient, severe
combo 1:
combo 2:

A

combo 1: levo/moxi + b-lactam
combo 2: b-lactam + macrolide

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32
Q

CAP empiric therapy, inpatient:
MRSA risk factors present, what 2 drugs

A
  • vanc
  • linezolid
33
Q

CAP empiric therapy, inpatient:
pseudomonas risk factors present, what 3 drugs

A
  • Piper/Tazo (Zosyn)
  • cefepime
  • meropenem
34
Q

3 risk factors for MRSA

A
  • 2-14 days post influenza
  • previous MRSA infection
  • previous hospitalization and use of IV antibiotics in last 90 days
35
Q

2 risk factors for Pseudomonas

A
  • previous pseudomonas infection
  • previous hospitalization and use of IV antibiotics within last 90 days
36
Q

T or F:
corticosteroids are a staple in treatment of non-severe CAP

37
Q

if corticosteroids arent recommended in CAP, when is the ONLY time they’d be considered

A

surviving sepsis guidelines when patient has CAP and septic shock *

38
Q

recommended duration of CAP therapy

A

minimum of 5 total days

39
Q

CAP clinical stability:
- Temp < __
- HR < ____
- RR < ___
- SBP > __

A
  • 38
  • 100
  • 24
  • 90
40
Q

aspiration pneumonia:
No _______ coverage recommended unless lung abscess or empyema present

41
Q

HAP= pneumo occuring > __ hours after hospitalization

42
Q

VAP= pneumo occuring > __ hours after endotracheal intubation

43
Q

some of the risk factors for HAP/VAP

A
  • old
  • comorbid diseases
  • duration of hospitalization
  • endotracheal tube
  • nasogastric tube
  • altered mental status *
  • surgery
  • previous antibiotic therapy
44
Q

what is the gold standard for diagnosing HAP/VAP

A

none idiot

45
Q

typical presentation of HAP/VAP

A

new lung infiltrate + clinical signs and sxs ( new onset fevre, purulent sputum, leukocytosis, decline in oxygenation)

46
Q

Common pathogens for HAP/VAP:
3 aerobic GN bacilli

A

pseudomonas
enteric GN bacilli (e. coli, kleb, citrobacter)
acinetobacter

47
Q

Common pathogens for HAP/VAP:
other one

A

staph aureus
(MRSA greater concern in this population)

48
Q

T or F:
invasive respiratory cultures have diagnostic threshold

A

true whatever that means

49
Q

Respiratory culture diagnostic threshold:
- may hold ________ based on threshold
- protected specimen brush < __ CFU/mL
- BAL: < __ CFU/mL

A
  • antibiotic
  • 10^3
  • 10^4
50
Q

what does MDR mean

A

multi drug resistant

51
Q

1 risk factor for MDR HAP

A

prior IV antibiotic use within 90 days

52
Q

1 risk factor for MRSA HAP/VAP

A

prior IV antibiotic use within 90 days

53
Q

2 risk factors for MDR pseudomonas aeruginosa

A
  • prior IV antibiotic use within 90 days
  • carbapenems, broad-spectrum b- lactams, FQs
54
Q

5 risk factors for MDR VAP

A
  • prior antibiotic use within 90 days
  • septic shock at time of diagnosis
  • acute respiratory distress syndrome prior to diagnosis
  • acute renal replacement therapy prior to VAP onset
  • > 5 days of hospitalization prior to diagnosis
55
Q

Empiric therapy - antibiotic choice:
MRSA coverage , 3 risk factors

A
  • typical risk factors for MRSA
  • ICUs where > 10-20% MRSA isolates
  • treatment where prevalence is unknown
56
Q

Empiric therapy - antibiotic choice:
MRSA coverage first line choices

A
  • vanc
  • linezolid
57
Q

Empiric therapy - antibiotic choice:
Pseudomonas coverage 2 risk factors

A
  • ICUs where >10% of isolates resistant
  • treatment where resistance rates are unknown
58
Q

Empiric therapy - antibiotic choice:
Pseudomonas coverage 5 drug choices

A
  • Piper/tazo
  • cefepime
  • imipenem
  • meropenem
  • levofloxacin
59
Q

Empiric therapy - HAP (NOT at high risk for mortality) :
goal

A

provide coverage for MSSA + pseudomonas

60
Q

Empiric therapy - HAP (NOT at high risk for mortality):
5 drug choices

A
  • Piper/tazo
  • cefepime
  • imipenem
  • meropenem
  • levofloxacin
61
Q

Empiric therapy - HAP (NOT at high risk for mortality, BUT MRSA risk):
drugs

A

same as last time with the 5 but also consider vanc or linezolid

62
Q

Empiric therapy - HAP ( HIGH risk for mortality and MRSA risk) (on ventilator support or septic shock):
goal

A

provide coverage for MRSA + MDR pseudomonas

63
Q

Empiric therapy - HAP ( HIGH risk for mortality and MRSA risk) (on ventilator support or septic shock):
drugs

A

PICK 2 DIFF CLASSES: **
- piper/tazo
- cefepime
- imipenem
- meropenem
- levofloxacin
- tobra/amikacin
+ vanc or linezolid

64
Q

Empiric therapy - VAP:
goal

A

provide coverage for MRSA + pseudomonas

65
Q

Empiric therapy - VAP:
when do you choose 2 anti-pseudomonals

A

risk factors for resistance

66
Q

Empiric therapy - VAP:
drugs

A

same as all the other shit with the vanc and linezolid too

67
Q

Non-beta lactam considerations:
when should daptomycin be used for LRTIs

A

never dumbass

68
Q

Non-beta lactam considerations:
Polymyxins (3)

A
  • avoid empiric use if possible
  • reserve for pts with high prevalence of MDR pathogens
  • Significant nephrotoxicity
69
Q

Non-beta lactam considerations:
AMGs (3)

A
  • recommend AGAINST use as monotherapy
  • avoid empiric use unless necessary
  • poor lung penetration, nephrotoxicity, ototoxicity, reports of lower clinical response rates
70
Q

Non-beta lactam considerations:
tigecycline (2)

A
  • great for polymicrobial infections BUT..
  • associated with increased mortality (rip)
71
Q

Pathogen-Specific therapy:
MSSA (2)

A

cefazolin, nafcillin

72
Q

Pathogen-Specific therapy:
Enterobacterales (1 class)

A

3rd gen cephs

73
Q

Pathogen-Specific therapy:
ESBL-producer (2)

A

carbapenem
ceftazidime/avibactam

74
Q

Pathogen-Specific therapy:
KPC-Producer (3)

A
  • meropenem/vaborbactam
  • imipenem/relebactam
  • ceftazidime/avibactam
75
Q

Pathogen-Specific therapy:
NDM/VIM-producer (2)

A
  • ceftazidime/avibactam + aztreonam
  • cefederocol
76
Q

Pathogen-Specific therapy:
Acinetobacter spp (3)

A
  • carbapenem
  • amp/sulb
  • cefiderocol
77
Q

duration of therapy for HAP/VAP

A

7 day if clinically stable

78
Q

does piperacillin/tazobactam cover ESBL producers

A

no, usually go to a carbapenem

PHRM 865 (32 decks)

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