Infectious Disease- UTI and Pneumonia Flashcards
Fever, productive cough, and consolidation on CXR
what is it?
what else do we need to consider?
Fever, productive cough, and consolidation on a CXR is the classic presentation of
PNEUMONIA
The next step is to determine if hte pneumonia is
CAP or HCAP.
If a patient has not had an x-ray, fever, chest pain, and a productive cough can indicate CAP.
What is CAP?
CAP is fever, productive cough, and consolidation on CXR
WITHOUT an association with healthcare facilities.
The most common cause of CAP is strep pneumo.
One must consider risk factors to determine the second most common cause.
Fever, productive cough, and consolidation on a CXR in a
pt with COPD or a smoker?
what is the most likely bug?
Fever, productive cough, and consolidation on a CXR in a
pt with COPD is caused by
H. flu
Fever, productive cough, and consolidation on a CXR in a
pt at risk for aspiration
what is the most likely causative organism?
The most likely organisms causing pneumonia in a
pt at risk for aspiration are
Klebsiella and other anaerobes
What is the most likely cause of CAP in a patient recovering from a viral illness
The most likely cause of CAP in a patient recovering from a viral illness is
S. Aureus
What is the most likely cause of CAP in an immunosuppressed patient?
pneumonia
+
immunosuppression
=
Legionella
How do you treat CAP?
Treat CAP with
moxifloxacin
or
3rd gen cephlasporin + macrolide
What are the most likely causes of HCAP?
The most likely causative organisms in HCAP are
Pseudomona
and
MRSA
How do you treat HCAP?
Treat HCAP with
piperacillin + tazobactam
and
Vancomycin
Fever + productive Cough + normal CXR
Bronchitis
treat bronchitis with
macrolide OR doxycycline OR moxifloxacin
Fever + productive cough + foul breath + cavitation on CXR
Abscess
treat an abscess with a
3rd generation cephalosporin + clindamycin
No need to drain
Fever + cough + immunocompromised
PCP
you may also see hypoxemia and an elevated LDH
Fever + Cough + myalgias/arthralgias/body aches
Fuckin’ flu.
How do you diagnose PCP?
diagnose PCP with a silver stain.
treat with Bactrim
(+) steroids IF patient has a low SPO2 or is hypoxic
remember- PCP will also have an elevated LDH
How do you treat the Flu?
treat the flu with
OSELAMIVIR
Cystitis + Urethral Discharge
=
?
Cystitis + Urethral Discharge =
Urethritis
Urethritis is an STD. do a urinary Gc/Chla
What is the treatment for urethritis?
Urethritis is characterized by cystitis + urethral discharge- especially if the patient is sexually active.
Treat for Gonorrhea and Chlamydia with
Ceftriaxone 250 mg IM x1
and Doxy 100mg x 7d or azithromycin 250 x 1
Which asymptomatic patients are screened for bacteriuria?
Pregnant women and anyone with a urologic procedure are screened for bacteriuria.
Do not treat asymptomatic bacteriuria unless there is a reason (Pregnancy or proceedure)
What is the abx of choice for asymptomatic bacteriuria in a pregnant female?
treat asymptomatic bacteriuria in a pregnant female with
AMOXICILLIN
if the patient is allergic to penicillins use
NITROFURANTOIN
frequency + urgency + dysuria
how do you treat it?
Cystitis
choose TMP-SMX, Nitro, or Fosfomycin
treat uncomplicated cystitis for 3 d
complicated cystitis for 7 d
What is complicated cystitis?
Complicated cystitis =
Penis
Plastic
Procedure
Pyelo
uncomplicated cystitis is a non-pregnant female
Signs of cystitis + CVA tenderness and a fever
what will you see on a UA that is pathognomonic for this condition?
WBC casts are pathognomonic for PYELONEPHRITIS.
make sure to get a UC to determine the type of abx used.
An inpatient with pyelonephritis will get
IV Ceftriaxone or IV Amp + Sulbactam.
Ambulatory pyelo pts will get PO Cipro.
A patient who has pyelonephritis but does not respond after 72 hrs to abx therapy.
what is the next step?
this patient probably has an abscess. Do a CT scan (unless the pt is pregnant or has renal failure- then do an US)
Drain the abscess and continue IV abx.
Asplenic patients need to be vacinated against which organisms?
Asplenic patients need to be vaccinated against encapsulated bacterina.
The only encapsulated bacteria with widely used vaccines are
Strep pneumo (pneumococcus)
PCV13 if immunization status is unknown
N. meningitides (meningococcal)
MCV4 if pt is under 55, otherwise give polysaccharide
H. influenza
