Exam 3 - LRTI Craft Flashcards
most common cause of infection-related hospitalization and mortality in the US
CAP
most common pathway for bacterial pneumonia
a. aspiration
b. aerosolization
c. bloodborne
a. aspiration
which microorganism is the most common pathogenic organism for CAP?
a. fungus
b. bacteria
c. virus
d. protozoa
c. virus
6 common bacterial pathogens for CAP
streptococcus pneumoniae
haemophilus influenzae
mycoplasma pneumoniae
legionella pneumophila
chlamydia pneumoniae
staphylococcus aureus
chest radiography for CAP: dense lobar consolidation or infiltrates
a. suspicion for bacterial origin
b. atypical or viral pathogen
a. suspicion for bacterial origin
chest radiography for CAP: patchy, diffuse, interstitial infiltrates
a. suspicion for bacterial origin
b. atypical or viral pathogen
b. atypical or viral pathogen
only evaluate sputum samples with > ___ PMNs and < ___ epithelial cells
> 25 PMNs
< 10 epithelial cells
2 severe CAP major criteria
-septic shock requiring vasopressors
-respiratory failure requiring mechanical ventilation
how many major criteria do you need to meet for severe CAP?
1
how many minor criteria need to be met for severe CAP?
at least 3
all the minor criteria for severe CAP (9 of them)
RR 30+
PaO2/FlO2 250 or less
Multilobar infiltrates
Confusion/disorientation
Uremia (BUN 20+)
Leukopenia (WBC < 4000)
Thrombocytopenia (plt < 100,000)
Hypothermia (temp < 36 C)
Hypotension requiring aggressive fluids
two clinical prediction tools for CAP
-pneumonia severity index (PSI)
-CURB-65
4 supportive measures for CAP
-humidified oxygen
-bronchodilators
-fluids
-chest physiotherapy
empiric therapy for healthy outpatient WITHOUT comorbidities or RF for abx resistance (3 options)
amoxicillin 1 gm PO Q8H
doxycycline 100 mg PO BID
azithromycin (Z-pak)
empiric therapy for outpatient adults with comorbidities: monotherapy
respiratory FQ (levo or moxi)
empiric therapy for outpatient adults with comorbidities: combination therapy
beta-lactam + macrolide or doxycycline
which is NOT a beta-lactam recommended for combination therapy in outpatient adults with comorbidities?
a. amox/clav
b. cefpodoxime
c. cefdinir
d. cefuroxime
c. cefdinir
empiric inpatient therapy for non-severe CAP: monotherapy
respiratory FQ (levo or moxi)
empiric inpatient therapy for non-severe CAP: combination therapy
beta-lactam + macrolide
recommended beta-lactams for inpatient CAP (2 of them)
-ampicillin/sulbactam
-ceftriaxone
empiric therapy for inpatient severe CAP: combination therapy (2 options)
-respiratory FQ + beta-lactam
-beta-lactam + macrolide
MRSA risk factors inpatient (3 of them)
-2-14 days post-influenza
-previous MRSA respiratory infection/isolation
-previous hospitalization and use of IV abx within last 90 days
pseudomonas aeruginosa risk factors inpatient (2 of them)
-previous p. aeruginosa respiratory infection
-previous hospitalization and use of IV abx within last 90 days
empiric therapy inpatient MRSA coverage (2 of them)
vancomycin
linezolid
empiric therapy inpatient p. aeruginosa coverage (3 of them)
-piperacillin/tazobactam
-cefepime
-meropenem
preferred therapy for penicillin-susc strep pneumoniae (2 of them)
-pen G
-amoxicillin
preferred therapy for penicillin-resistant strep pneumoniae (2 of them)
-ceftriaxone
-respiratory FQ
preferred therapy for H. influenzae (3 of them)
2nd/3rd gen ceph; unasyn; augmentin
preferred therapy for mycoplasma or chlamydia pneumoniae (2 of them)
macrolide or doxycycline
preferred therapy for legionella (2 of them)
FQ; azithromycin
preferred therapy for MSSA (2 of them)
cefazolin; nafcillin
preferred therapy for MRSA (2 of them)
vancomycin; linezolid
preferred therapy for anaerobes
beta-lactam/inhibitor combo; add metronidazole if utilizing cephalosporin
preferred therapy for enterobacterales (2 of them)
3rd/4th gen ceph; carbapenem
when do we use corticosteroids for CAP?
only when pt has CAP and septic shock
CAP therapy should be a minimum of ___ total days
5
