Final Quiz: CAP/HCAP Flashcards
CURB-65
Confusion Urea > 19 mg/dL Resp. Rate > 30 BP: SBP < 90 or DBP /< 60 Age >/ 65
How to use CURB-65 score
0 = Outpatient 1 = Outpatient 2 = Inpatient 3 = Inpatient, possible ICU 4 = ICU 5 = ICU
Pathogens of concern with CAP
S. pneumoniae * H. influenzae M. pneumoniae C. pneumoniae \+ Pseudomonas MRSA
When would you worry about atypicals in CAP?
If patient has significant PMH:
- Heart, lung, liver, renal disease, or malignancy.
If patient is immunosuppressed.
If patient has problems with alcohol.
If patient has had antibiotics within last 90 days.
CAP diagnosis requires:
Appropriate constellation of signs and symptoms
AND
Radiographic findings
When would you worry about MRSA in CAP?
Gram + cocci in clusters ESRD IVDA Recent influenza Recent ABX use
When would you worry about Pseudomonas in CAP?
Gram - rods
Structural lung disease
Repeated COPD exacerbations
Prior antibiotic therapy
Empiric treatment of simple outpatient
Azithromycin
OR
Doxycycline
Covering for:
S. pneumo, atypicals
Empiric treatment of outpatient with comorbidities
Amoxicillin + Azithro/Doxy
OR
Levofloxacin
Covering for:
S. pneumo, atypicals
Empiric treatment of inpatient non-ICU
IV Ceftriaxone + Azithro/doxy
OR
Levofloxacin
Covering for:
S. pneumo, atypicals including legionella
Empiric treatment of inpatient ICU
IV Cetriaxone + Azithro OR Levofloxacin OR Aztreonam + Levofloxacin (pen allergy)
Covering for:
S.pneumo, legionella, gram-negatives, and H.flu
Empiric treatment of Pseudomonas-CAP
Cefepime (Aztreonam if pen allergy)
PLUS
Cipro/Levo OR Gent and Azithro
Covering for:
Pseudomonas, S. pneumo, atypicals, gram-negatives
Empiric treatment of MRSA-CAP
- In addition to empiric regimen *
Vancomycin
or
Linezolid
HCAP Pathogens
S. aureus (MRSA and MSSA)
Pseudomonas
Klebsiella
Other gram negatives
HCAP treatment decision
IV ABX w/90 days Septic Needs mech. vent. - Use dual-antipseudomonal coverage - ALSO cover MRSA
Non of those factors: MRSA prevalence >/20% or unknown - add MRSA coverage Known MRSA prevalence < 20% - Not vanco or linezolid Sputum with gram negatives or structural lung disease - add dual antipseudomonal Sputum/lung disease negative - add monopseudomonal coverage
