Infectious Disease- UTI and Pneumonia

Question 1

Fever, productive cough, and consolidation on CXR

what is it?

what else do we need to consider?

Answer 1

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.

Question 2

What is CAP?

Answer 2

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.

Question 3

Fever, productive cough, and consolidation on a CXR in a

pt with COPD or a smoker?

what is the most likely bug?

Answer 3

Fever, productive cough, and consolidation on a CXR in a

pt with COPD is caused by

H. flu

Question 4

Fever, productive cough, and consolidation on a CXR in a

pt at risk for aspiration

what is the most likely causative organism?

Answer 4

The most likely organisms causing pneumonia in a

pt at risk for aspiration are

Klebsiella and other anaerobes

Question 5

What is the most likely cause of CAP in a patient recovering from a viral illness

Answer 5

The most likely cause of CAP in a patient recovering from a viral illness is

S. Aureus

Question 6

What is the most likely cause of CAP in an immunosuppressed patient?

Answer 6

pneumonia

+

immunosuppression

=

Legionella

Question 7

How do you treat CAP?

Answer 7

Treat CAP with

moxifloxacin

or

3rd gen cephlasporin + macrolide

Question 8

What are the most likely causes of HCAP?

Answer 8

The most likely causative organisms in HCAP are

Pseudomona

and

MRSA

Question 9

How do you treat HCAP?

Answer 9

Treat HCAP with

piperacillin + tazobactam

and

Vancomycin

Question 10

Fever + productive Cough + normal CXR

Answer 10

Bronchitis

treat bronchitis with

macrolide OR doxycycline OR moxifloxacin

Question 11

Fever + productive cough + foul breath + cavitation on CXR

Answer 11

Abscess

treat an abscess with a

3rd generation cephalosporin + clindamycin

No need to drain

Question 12

Fever + cough + immunocompromised

Answer 12

PCP

you may also see hypoxemia and an elevated LDH

Question 13

Fever + Cough + myalgias/arthralgias/body aches

Answer 13

Fuckin’ flu.

Question 14

How do you diagnose PCP?

Answer 14

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

Question 15

How do you treat the Flu?

Answer 15

treat the flu with

OSELAMIVIR

Question 16

Cystitis + Urethral Discharge

=

?

Answer 16

Cystitis + Urethral Discharge =

Urethritis

Urethritis is an STD. do a urinary Gc/Chla

Question 17

What is the treatment for urethritis?

Answer 17

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

Question 18

Which asymptomatic patients are screened for bacteriuria?

Answer 18

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)

Question 19

What is the abx of choice for asymptomatic bacteriuria in a pregnant female?

Answer 19

treat asymptomatic bacteriuria in a pregnant female with

AMOXICILLIN

if the patient is allergic to penicillins use

NITROFURANTOIN

Question 20

frequency + urgency + dysuria

how do you treat it?

Answer 20

Cystitis

choose TMP-SMX, Nitro, or Fosfomycin

treat uncomplicated cystitis for 3 d

complicated cystitis for 7 d

Question 21

What is complicated cystitis?

Answer 21

Complicated cystitis =

Penis

Plastic

Procedure

Pyelo

uncomplicated cystitis is a non-pregnant female

Question 22

Signs of cystitis + CVA tenderness and a fever

what will you see on a UA that is pathognomonic for this condition?

Answer 22

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.

Question 23

A patient who has pyelonephritis but does not respond after 72 hrs to abx therapy.

what is the next step?

Answer 23

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.

Question 24

Asplenic patients need to be vacinated against which organisms?

Answer 24

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