Lower Respiratory Tract Infection Flashcards
What is pneumonia?
acute infection of alveoli causing inflammation & fluid or pus accumulation
LRTI Signs and Symptoms
Sputum production
Tachycardia
Tachypnea
Hemoptysis
Pleuritic chest pain
Increased WBC
Diminished Breath Sounds
Dyspnea
Gram +ve diplococci
S. pneumoniae
Cluster of gram +ve cocci
S. aureus
Tiny gram -ve coccobacilli
H. influenzae
gram -ve diplococci
M. catarrhalis
plump gram -ve rods
Klebsiella
Gram -ve rods
P. aeruginosa
Diagnosis of LRTI
Sputum Culture in severe hospitalized
***obtain before ABx
Other LRTI Diagnostic
- Bronchoalveolar Lavage (BAL)
CURB - 65
Confusion = 1
Uremia (BUN>20)
Resp Rate (>30/min) = 1
SBP <90/DBP <60
Age >65 yrs = 1
CURB-65 ratings
0-1 = outpatient
2 = inpatient
>3 = ICU
HAP
48 hrs after admission
community pts w/ IV ABx within 90 days of admission
VAP
> 48 hrs after endotracheal intubation
CAP
no exposure to healthcare system
Most common CAP pathogens?
S. pneumoniae
CAP pathogens covered empirically>
S. pneumoniae
H. influenzae
Atypicals
Typical Pneumonia (primary pulmonary symptoms)
Abrupt onset
Unilateral infiltrate
Significant fever, chills
Purulent sputum production
Atypical Pneumonia (extrapulmonary symptoms)
Gradual onset
Dry cough
Diffuse infiltrates
CAP Outpatient Treatment in Healthy Patients
PO Amoxicillin
PO Doxycycline
PO Macrolides (Azithro/Clarithro)
CAP Outpatient Treatment in ppl with comorbidities
PO Augumentin
Cephalosporin + Macrolide (A/C)
Respiratory Fluoroquinolone (Levo/Moxi)
CAP Inpatient Treatment Non-Severe
IV B-Lactam + Macrolide
IV B-Lactam + Respiratory Fluoroquinolone
CAP Inpatient Treatment Severe
IV B-Lactam + Macrolide
IV B-Lactam +Respiratory Fluroquinolone
IV B-Lactam used in CAP
Ampicillin/Sulbactam (Unasyn)
Ceftriaxone
What respiratory cultures should you take and possibly treat?
MRSA and Pseudomonal
Duration of Therapy for CAP Treatment
Minimum of 5 days (~7)
Afebrile for 48 - 72 hours
Pretreatment for CAP
sputum and blood culture - antiMRSA and antiPseudomonal
Test for severe CAP
urinary Ag test for Legionella & S. pneumoniae
Bacterial Etiology for VAP
gram -ve organisms within 3 - 5 days
When do you cover pseudomonas empirically?
prior IV ABx use in 90 days
severe presentation (sepsis/ventilator)
previous pseudomonal infection
immunosuppression
ABx for HAP Pseudomonas
Piperacillin/Tazobactam (Frequent dosing)
Cefepime (No Anerobic)
Ceftazidime
HAP culture test
sputum sample non-invasively then BAL if possible
VAP culture test
non-invasive of semi-quantitative cultures
Duration of HAP ABx Treatment
7 days
Duration of VAP ABx Treatment
7 days
