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PR3151_Final Exam > Lower Respiratory Tract Infection > Flashcards

Lower Respiratory Tract Infection Flashcards

1
Q

What is the definition of acute bronchitis?

A

acute cough <3w due to inflammation of trachea and lower airways

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2
Q

are antibiotics recommended in the treatment of acute bronchitis?

A

No

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3
Q

How does acute bronchitis usually start?

A

from a viral URTI

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4
Q

What are the expected radiographic findings for pneumonia?

A

evidence of new infiltrates / dense consolidations, usually unilateral

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5
Q

What urinary antigen tests are available for pneumonia?

A

s. pneumonia, legionella

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6
Q

What are the limitations of urinary antigen tests for pneumonia?

A

only indicates exposure, remains positive even with appropriate treatment

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7
Q

For whom are urinary antigen tests recommended?

A

severe CAP or hospitalised patients

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8
Q

For whom should pre-treatment blood and respiratory cultures be obtained?

A

Patients in the hospital who have:
- Severe CAP
- have MRSA and pseudomonas risk factors (being empirically treated for either, infected with either in the past 1 year, hospitalised or received IV antibiotics in the last 90 days)

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9
Q

What are the risk factors for pneumonia?

A
  • smoking
  • chronic lung condition
  • immunosuppression
  • swallowing impairment (increased risk of aspiration)
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10
Q

What is the definition of community-acquired pneumonia?

A

Onset in the community / < 48H after admission

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11
Q

Outline the CURB-65 risk stratification tool.

A

Confusion
Urea > 7mm
Respiratory rate >=30
SBP < 90 / DBP < 60
Age >= 65
0-1: outpatient treatment
2: inpatient treatment
>=3: inpatient, consider ICU

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12
Q

What are the 2 major criteria for severe CAP?

A
  • mechanical ventilation
  • septic shock requiring vasoactive medications
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13
Q

What are the 8 minor criteria for severe CAP?

A
  • Urea > 7
  • Respiratory rate >= 30
  • PaO2/FiO2 <= 250
  • multilobar infiltrates
  • confusion
  • WBC < 4
  • hypothermia < 36c
  • hypotension requiring aggressive fluid resuscitation
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14
Q

What pathogen(s) is/are implicated in patients with CAP with no comorbidities treated in the outpatient setting?

A

s. pneumoniae

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15
Q

What are the recommended regimens for patients with CAP with no comorbidities treated in the outpatient setting?

A

PO amoxicillin 1g Q8H OR levofloxacin / moxifloxacin

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16
Q

What pathogen(s) is/are implicated in patients with CAP with comorbidities treated in the outpatient setting?

A

s. pneumoniae, h. influenzae, atypical bacteria

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17
Q

What are the recommended regimens for patients with CAP with comorbidities treated in the outpatient setting?

A

PO amox-clav / PO cefuroxime AND clarithromycin / azithromycin / doxycycline OR respiratory fluoroquinolones

18
Q

What pathogen(s) is/are implicated in patients with non-severe CAP treated in the inpatient setting?

A

s. pneumoniae, h. influenzae, atypical bacteria

19
Q

What are the MRSA risk factors for patients with non-severe CAP treated in the inpatient setting?

A

Respiratory isolation of MRSA in the past 1 year / prior hospitalisation or abx use in the last 90 days AND MRSA PCR screen positive

20
Q

What are the pseudomonas risk factors for patients with non-severe CAP treated in the inpatient setting?

A

respiratory isolation of pseudomonas in the last 1 year

21
Q

What agents should be included in the treatment of patients with non-severe / severe CAP with MRSA risk factors?

A

IV Vancomycin / IV/PO linezolid

22
Q

What agents may be considered in the modification of treatment of patients with non-severe CAP with pseudomonas risk factors?

A

pip-tazo, meropenem, cefepime, ceftazidime, levofloxacin

23
Q

What are the MRSA risk factors for patients with severe CAP treated in the inpatient setting?

A

respiratory isolation of MRSA in the past 1 year OR prior hospitalisation or abx use in the last 90 days

24
Q

What are the pseudomonas risk factors for patients with severe CAP treated in the inpatient setting?

A

respiratory isolation of pseudomonas in the past 1 year OR prior hospitalisation or abx use in the last 90 days

25
Q

What pathogen(s) is/are implicated in patients with severe CAP treated in the inpatient setting?

A

s. pneumoniae, h. influenzae, atypical, gram neg (klebsiella, burkholderia), s. aureus

26
Q

What agents should be added in patients with lung abscess / empyema?

A

metronidazole (first choice) / clindamycin

27
Q

what are the recommended treatment regimens for non-severe CAP treated in the inpatient setting?

A
  1. IV amox-clav / cefuroxime / ceftriaxone + azithromycin / clarithromycin / doxycycline
  2. respiratory fluoroquinolone
28
Q

what are the recommended treatment regimens for severe CAP treated in the inpatient setting?

A

IV amox-clav / penicillin G + ceftazidime + azithromycin / clarithromycin OR
respiratory fluoroquinolone + ceftazidime
(ceftazidime is for burkholderia)

29
Q

Why are respiratory fluoroquinolones not first-line for the treatment of pneumonia?

A
  • high adverse effects
  • mask symptoms of TB
  • collateral damage with 3rd / 4th gen cephalosporins
30
Q

What should be added to pneumonia treatment if influenza is suspected?

A

Oseltamivir

31
Q

For CAP de-escalation, abx covers for which bacteria can be dropped, if there are no available cultures?

A

MRSA, pseudomonas, burkholderia

32
Q

What is the recommended treatment duration for CAP?

A

minimum 5d, 7d for MRSA / pseudomonas suspected / proven
longer for deep-seated infections and uncommon pathogens

33
Q

When should chest x-ray be repeated?

A

only if there is a deterioration in the patient’s condition

34
Q

What is the definition of HAP / VAP?

A

onset >= 48H after admission / mechanical ventilation

35
Q

What are the risk factors for HAP and VAP?

A

as per pneumonia + supine position, deep sedation, prior abx use, opiods, mechanical ventilation

36
Q

What pathogens should be empirically covered for HAP / VAP?

A

pseudomonas and s. aureus

37
Q

What are the MRSA risk factors for HAP / VAP?

A
  • isolation of MRSA in the last 1 year
  • prior IV abx use within the last 90 days
  • hospital unit > 20% of s. aureus is MRSA
  • patient is at high risk for mortality
38
Q

When should double pseudomonal cover be considered?

A
  1. patient has risk factors for pseudomonal resistance (prior IV abx use, isolation of pseudomonas in the last 1 year, acute renal replacement therapy prior to VAP onset)
  2. hospital unit where >10% of pseudomonas is resistant to agent considered for monotherapy
  3. patient is at high risk for mortality
39
Q

Should aminoglycosides be used as monotherapy?

A

no

40
Q

What are the recommended regimens for HAP / VAP?

A

pip-tazo / cefepime / ceftazidime / meropenem / imipenem AND/OR anti-pseudomonal FQ OR amikacin

41
Q

What is the recommended treatment duration for HAP / VAP?

A

7 days regardless of pathogen

42
Q

For de-escalation in HAP / VAP, what pathogen cover should be maintained if culture / antibiogram is not available?

A

pseudomonas, s. aureus, enteric gram neg
(can drop MRSA if no MRSA in culture, unless patient very sick)

PR3151_Final Exam (8 decks)

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