Lower Respiratory Tract Infection Flashcards
What is the definition of acute bronchitis?
acute cough <3w due to inflammation of trachea and lower airways
are antibiotics recommended in the treatment of acute bronchitis?
No
How does acute bronchitis usually start?
from a viral URTI
What are the expected radiographic findings for pneumonia?
evidence of new infiltrates / dense consolidations, usually unilateral
What urinary antigen tests are available for pneumonia?
s. pneumonia, legionella
What are the limitations of urinary antigen tests for pneumonia?
only indicates exposure, remains positive even with appropriate treatment
For whom are urinary antigen tests recommended?
severe CAP or hospitalised patients
For whom should pre-treatment blood and respiratory cultures be obtained?
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)
What are the risk factors for pneumonia?
- smoking
- chronic lung condition
- immunosuppression
- swallowing impairment (increased risk of aspiration)
What is the definition of community-acquired pneumonia?
Onset in the community / < 48H after admission
Outline the CURB-65 risk stratification tool.
Confusion
Urea > 7mm
Respiratory rate >=30
SBP < 90 / DBP < 60
Age >= 65
0-1: outpatient treatment
2: inpatient treatment
>=3: inpatient, consider ICU
What are the 2 major criteria for severe CAP?
- mechanical ventilation
- septic shock requiring vasoactive medications
What are the 8 minor criteria for severe CAP?
- Urea > 7
- Respiratory rate >= 30
- PaO2/FiO2 <= 250
- multilobar infiltrates
- confusion
- WBC < 4
- hypothermia < 36c
- hypotension requiring aggressive fluid resuscitation
What pathogen(s) is/are implicated in patients with CAP with no comorbidities treated in the outpatient setting?
s. pneumoniae
What are the recommended regimens for patients with CAP with no comorbidities treated in the outpatient setting?
PO amoxicillin 1g Q8H OR levofloxacin / moxifloxacin
What pathogen(s) is/are implicated in patients with CAP with comorbidities treated in the outpatient setting?
s. pneumoniae, h. influenzae, atypical bacteria
What are the recommended regimens for patients with CAP with comorbidities treated in the outpatient setting?
PO amox-clav / PO cefuroxime AND clarithromycin / azithromycin / doxycycline OR respiratory fluoroquinolones
What pathogen(s) is/are implicated in patients with non-severe CAP treated in the inpatient setting?
s. pneumoniae, h. influenzae, atypical bacteria
What are the MRSA risk factors for patients with non-severe CAP treated in the inpatient setting?
Respiratory isolation of MRSA in the past 1 year / prior hospitalisation or abx use in the last 90 days AND MRSA PCR screen positive
What are the pseudomonas risk factors for patients with non-severe CAP treated in the inpatient setting?
respiratory isolation of pseudomonas in the last 1 year
What agents should be included in the treatment of patients with non-severe / severe CAP with MRSA risk factors?
IV Vancomycin / IV/PO linezolid
What agents may be considered in the modification of treatment of patients with non-severe CAP with pseudomonas risk factors?
pip-tazo, meropenem, cefepime, ceftazidime, levofloxacin
What are the MRSA risk factors for patients with severe CAP treated in the inpatient setting?
respiratory isolation of MRSA in the past 1 year OR prior hospitalisation or abx use in the last 90 days
What are the pseudomonas risk factors for patients with severe CAP treated in the inpatient setting?
respiratory isolation of pseudomonas in the past 1 year OR prior hospitalisation or abx use in the last 90 days
