IC16 LRTI Flashcards by Dylan Lye

How can pneumonia be spread? (3)

Oropharyngeal secretions
Inhalation of aerosols
Hematogenous spreading

How well did you know this?

Not at all

Perfectly

What are the three main risk factors for development of pneumonia?

Smoking
Chronic conditions
Immunosuppression

How well did you know this?

Not at all

Perfectly

How does smoking increase risk for pneumonia development?

Smoking suppresses neutrophil function and damages the lung epitheliun

How well did you know this?

Not at all

Perfectly

What are the SYSTEMIC s/sx of pneumonia?

Fever, chills, malaise, confusion in elderly, hypotension and tachycardia

How well did you know this?

Not at all

Perfectly

What are the LOCAL s/sx of pneumonia?

cough, chest pain on coughing, shortness of breath, thacypnea, hypoxia, increased sputum production

How well did you know this?

Not at all

Perfectly

What is the significance of radiographic findings in pneumonia?

CXR is the most important for diagnosis, requires new infiltrates or dense consolidations

How well did you know this?

Not at all

Perfectly

When should the urinary antigen test be done for pneumonia?

In severe CAP or hospitalised patients

How well did you know this?

Not at all

Perfectly

What sources should respiratory gram stain and culture be taken? (2)

Sputum or LRT sample

How well did you know this?

Not at all

Perfectly

What are the pros and cons of using sputum for testing?

Not invasive
Prone to contamination, low yield

How well did you know this?

Not at all

Perfectly

What are the pros and cons of using LRT for testing?

Less contamination
Invasive

How well did you know this?

Not at all

Perfectly

How is CAP classified?

Onset in the community or less than 48h after admission

How well did you know this?

Not at all

Perfectly

How is HAP classified?

Onset >= 48h after admission

How well did you know this?

Not at all

Perfectly

How is VAP classified?

Onset >= 48h after starting mechanical ventilation

How well did you know this?

Not at all

Perfectly

What are the common pathogens for outpatient or non-severe inpatient? (3)

Strep pneuno
H. influenzae
Atypicals

How well did you know this?

Not at all

Perfectly

What are the common pathogens for inpatient severe? (5)

Strep pneuno
H. influenzae
Atypicals
S aureus
GN bacilli

How well did you know this?

Not at all

Perfectly

What is CURB65 used for?

Determines inpatient/outpatient in CAP

What are the CURB65 components?

Confusion (new onset)
Urea > 7mmol/L
RR >= 30 bpm
BP (sbp < 90 or dbp <= 60)
Age >= 65

What is the IDSA minor/major criteria used for?

Determine severe CAP

one or more major OR
thee or more minor

What are the 2 major criteria for IDSA

Mechanical ventilation
Septic shock requiring vasoactive medications

What are the 8 minor criteria for IDSA

RR >= 30 bpm
Urea > 7 mmol/L
Leukopenia (WBC < 4 x 10^9 /L)
Confusion or disorientation
PO2 FiO2 < 250
Hypothermia (core temp < 36ºC)
Multilobar infiltrates
Hypotension requiring aggressive fluid resuscitation

What are empiric treatment options for outpatient CAP with no comorbidities?

(hint: rmb the table!)

PO Amoxicillin 1g q8h
PO Levofloxacin 750mg OD
PO Moxifloxacin (no dose)

What are empiric treatment options for outpatient CAP with comorbidities or inpatient non-severe CAP?

(hint: rmb the table!)

PO Amoxicillin-clavulanate 625mg TDS
PO Cefuroxime 500mg BD
(with)
PO Azithromycin 500mg OD
PO Clarithromycin 500mg BD
PO Doxycycline 100mg BD

OR
PO Levofloxacin 750mg OD
PO Moxifloxacin (no dose)

What are empiric treatment options for severe inpatient CAP

(rmb the combination of 3!!, cover for burkholderia)
(hint: cover for 3, so 3rd gen)

IV Amoxicillin-clavulanate* 625mg TDS
IV Penicillin G (no dose)
(with)
IV Clarithromycin 500mg BD
IV Azithromycin 500mg OD
(with)
IV Ceftazidime 2g q8h

PO Levofloxacin 750mg OD
PO Moxifloxacin* (no dose)
(with)
IV Ceftazidime 2g q8h

Which fluoroquinolone covers pseudomonas and which doesnt?

Lefloxacin covers
Moxifloxacin does not cover

What should you cover if there is a lung abcess or empyema?

Cover for anaerobes If standard regimen does not cover, add IV metronidazole or IV/PO Ciprofloxacin

Respiratory quinolones are NOT first-line. What are the prominent side effects associated with them? (4)

Tendonitis, tendon rupture QTc prolongation CNS disturbances Hypoglycemia

How long should CAP be treated for?

5 days

What can be done for patients on mechanical ventilation to reduce instances of VAP? (3)

1. Limit duration of mechanical ventilation 2. Minimise levels of deep sedation 3. Elevate the bed head by 30º

What 2 pathogens should be empirically covered in HAP/VAP?

Pseudomonas and S. aureus

What are MRSA risk factors? (4) (cover for MRSA if any ONE of the following)

1. post IV abx use in the last 90 days 2. isolation of MRSA in the last 1 year 3. hospitalisation in a unit where MRSA makes up > 20% of S. aureus cases 4. MRSA prevalence not known but patient at high mortality risk

What are Pseudomonas risk factors? (3) (cover for pseudomonas if any ONE of the following)

1. Risk factors for antimicrobial resistance (IV abx in last 90 days, acute RRT, isolation of pseudomonas in last 1 year) 2. Hospitalisation in a unit where > 10% of pseudomonas is resistant to an agent being considered for monotherapy 3. Unknown pseudomonas prevalence but high mortality risk

Why should aminoglycosides not be used as monotherapy in HAP/VAP?

Very toxic, high risk of nephrotoxocity and ICU patients are already hemodynamically unstable hence giving them a higher risk for nephrotoxicity

What drugs should be used for pseudomonas cover in HAP/VAP? (5) (hint: PseudoMonal Cover = PMC)

IV Piperacillin-tazobactam 4.5g q6h IV Cefepime 2g q8h IV Ceftazidime 2g q8h IV Meropenem 1g q8h IV Imipenem-Cilastatin 500mg q8h

What agents can be added on for double pseudomonal cover in HAP/VAP? (4) (hint: 2 classes)

IV Levofloxacin 750mg OD IV Ciproflixacin 400mg BD (or) IV Gentamicin 5mg/kg OD IV Amikacin 15mg/kg OD

What agents can be added for MRSA cover in HAP/VAP? (2)

(add) IV Vancomycin 15mg/kg q8h PO/IV Linezolid 600mg q12h

How long should HAP/VAP be treated for?

7 days, extend to 10 if need 2-3 weeks if deep seated infections 4-6 weeks for less common bacteria