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PR3151 Revision > IC16 LRTI > Flashcards

IC16 LRTI Flashcards

1
Q

How can pneumonia be spread? (3)

A
  1. Oropharyngeal secretions
  2. Inhalation of aerosols
  3. Hematogenous spreading
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2
Q

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

A

Smoking
Chronic conditions
Immunosuppression

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3
Q

How does smoking increase risk for pneumonia development?

A

Smoking suppresses neutrophil function and damages the lung epitheliun

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4
Q

What are the SYSTEMIC s/sx of pneumonia?

A

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

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5
Q

What are the LOCAL s/sx of pneumonia?

A

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

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6
Q

What is the significance of radiographic findings in pneumonia?

A

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

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7
Q

When should the urinary antigen test be done for pneumonia?

A

In severe CAP or hospitalised patients

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8
Q

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

A

Sputum or LRT sample

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9
Q

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

A

Not invasive
Prone to contamination, low yield

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10
Q

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

A

Less contamination
Invasive

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11
Q

How is CAP classified?

A

Onset in the community or less than 48h after admission

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12
Q

How is HAP classified?

A

Onset >= 48h after admission

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13
Q

How is VAP classified?

A

Onset >= 48h after starting mechanical ventilation

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14
Q

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

A

Strep pneuno
H. influenzae
Atypicals

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15
Q

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

A

Strep pneuno
H. influenzae
Atypicals
S aureus
GN bacilli

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16
Q

What is CURB65 used for?

A

Determines inpatient/outpatient in CAP

17
Q

What are the CURB65 components?

A

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

18
Q

What is the IDSA minor/major criteria used for?

A

Determine severe CAP

one or more major OR
thee or more minor

19
Q

What are the 2 major criteria for IDSA

A

Mechanical ventilation
Septic shock requiring vasoactive medications

20
Q

What are the 8 minor criteria for IDSA

A

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

21
Q

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

(hint: rmb the table!)

A

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

22
Q

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

(hint: rmb the table!)

A

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)

23
Q

What are empiric treatment options for severe inpatient CAP

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

A

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

OR

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

24
Q

Which fluoroquinolone covers pseudomonas and which doesnt?

A

Lefloxacin covers
Moxifloxacin does not cover

25
Q

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

A

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

26
Q

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

A

Tendonitis, tendon rupture
QTc prolongation
CNS disturbances
Hypoglycemia

27
Q

How long should CAP be treated for?

A

5 days

28
Q

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

A
  1. Limit duration of mechanical ventilation
  2. Minimise levels of deep sedation
  3. Elevate the bed head by 30º
29
Q

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

A

Pseudomonas and S. aureus

30
Q

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

A
  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
31
Q

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

A
  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
32
Q

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

A

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

33
Q

What drugs should be used for pseudomonas cover in HAP/VAP? (5)

(hint: PseudoMonal Cover = PMC)

A

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

34
Q

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

A

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

35
Q

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

A

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

36
Q

How long should HAP/VAP be treated for?

A

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

PR3151 Revision (7 decks)

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