Lower Respiratory Tract Infections Flashcards
Bronchitis
What is the causitive pathogens of bronchitis?
- VIRUSES! > 90% of cases
- bacteria (atypical organisms)= mycoplasma pneumoniae, chlamydia pneumoniae, bordatella pertussis (whopping cough)
Bronchitis
When is acute bronchitis treated?
if the infection is caused by bordatella pertussis (whopping cough)
Bronchitis
What antibiotics are used to treat Bordatella pertussis?
- macrolide
- sulfamethoxazole/trimethoprim
Pneumonia
What is the diagnosis criteria of pneumonia?
new lung inflitrate + clinical evidence for an infectious origin (fever, purulent sputum, leukocytosis, decreased oxygenation)
Pneumonia
What is the cause of pneumonia?
- aspiration (suble aspiration common in all indivuals, but risk factors may predispose pt)
- inhalation
- hematogenous
Pneumonia
What are the risk factors for pneumonia?
- viral infections predispose pt to secondary bacterial pneumonia (commonly seen in elderly)
- hospitalization
- mechanical ventilation
- smoking
- alcoholism
- elderly
- immunosuppresion
Pneumonia
How is hospital acquired pneumonia (HAP) classified?
pneumonia that occurs > 48 hours after admission to the hospital and was not incubated at the time of admission
Pneumonia
How is ventilator acquired pneumonia (VAP) classified?
pneumonia that occurs > 48 hours after endotracheal intubation
~9-27% incidence rate of intubated patient, risk increases with time
Pneumonia
What is the cause of aspiration pneumonia?
large inoculum of less virulent pathogens (anaerobes- normal flora)
Pneumonia
What are the risk factors for aspiration pneumonia?
- drugs
- altered mental status
- impaired host defenses (cough/gag reflex)
- neuromuscular disease
- dysphagia (history of stroke)
- mechanical ventilation, bronchoscopy, nasogastric feeding
Pneumonia
What is the clinical presentation of pneumonia?
- cough
- dyspnea
- sputum production
- pleuritic chest pain
- signs of systemic infection (fever, chills, hypoxemia, tachycardia, tachypnea)
peds: grunting, retractions, nasal flaring
Pneumonia
What labs and diagnostic tests can be used to diagnosis pneumonia?
- chest Xray
- sputum culture
- blood culture
- pulse oximetry
- WBCs
- urine antigen testing
- rapid influenza molecular assay (especially during the season in the elderly)
Pneumonia
What are the common pathogens that are respondsible for community acquired pneumonia (CAP)?
- streptococcus pneumoniae
- haemophilus influenzae
- staphylococcus aureus
- mycoplasma pneumoniae
- legionella species (serious illness)
- chlamydia pneumoniae
- moraxella catarrhalis
Pneumonia
What are the common pathogens that are respondsible for hospital acquired pneumonia (HAP)?
- escherichia coli
- staphylococcus aureus
- klebsiella pneumoniae
- acinetobacter spp.
- pseudomonas aeruginosa
- enterobacter spp.
Pneumonia
What is the most common bacterial pathogen that causes pneumonia in ages birth- 3 weeks?
group B strep
Pneumonia
What is the most common bacterial pathogen that causes pneumonia in ages 3 weeks- 3 months?
- streptococcus pneumoniae
- bordatella pertussis
viruses= RSV
Pneumonia
What is the most common bacterial pathogen that causes pneumonia in ages 3 months-5 years?
streptococcus pneumoniae
VIRUSES
Pneumonia
What is the most common bacterial pathogen that causes pneumonia in ages 5 years- 15 years?
atypical organisms
- mycoplasma pneumoniae
- chlamydophila pneumoniae
- streptococcus pneumoniae
Pneumonia
What is the criteria for community acquired pneumonia (CAP) to be considered severe?
major criteria
- septic shock with the need for vasopressors
- respiratory failure requiring mechanical ventilation
lots of minor criteria, but focus on major criteria
Pneumonia
What is the CURB-65?
5 criteria to assess whether the pt may be treated inpatient or outpatient, score of 2+ = hospitalization or agressive home care due to increased risk of mortality
- Confusion
- BUN > 20mg/dL
- Respiratory rate 30+ bpm
- Blood pressure <90/<60mmHg
- Age 65+
Pneumonia
What is the standard regimen for community acquired pneumonia (CAP) treatment outpatient?
- amoxicillin 1 g PO TID
- doxycycline 100 mg PO BID
- levofloxacin 750 mg PO daily
no comorbities or risk factors for MRSA or pseudomonas aeruginosa
Pneumonia
What is the standard regimen for community acquired pneumonia (CAP) treatment for patient’s with comorbidites outpatient?
- amoxicillin OR cephalosporin (2nd or 3rd gen) AND macrolide OR doxycycline
- respiratory fluroquinolone (levofloxacin)
heart/lung/liver/renal disease, DM, alcoholism, malignancy, asplenia
Pneumonia
What is the treatment for non-severe community acquired pneumonia (CAP) inpatient?
beta-lactam + advanced macrolide (clarithromycin or azithromycin) OR respiratory fluroquinolone (levofloxicin or moxifloxacin)
Pneumonia
What is the treatment for severe community acquired pneumonia (CAP) inpatient?
beta-lactam + advanced macrolide (clarithromycin or azithromycin) OR beta-lactam + respiratory fluroquinolone (levofloxacin or moxifloxacin)
Pneumonia
What is the first line treatment for pneumonia for appropiately immunized preschool aged children?
amoxicillin or amoxicillin/clavulanate
Pneumonia
What is the first line treatment for pneumonia for school aged children (> 5 years old)?
amoxicillin + azithromycin
Pneumonia
What is the treatment duration of treatment for community acquired pneumonia (CAP)?
5+ days, 7 days for MRSA or P. aeruginosa
Pneumonia
What are the risk factors for high mortality in hospital acquired pneumonia?
- ventilator support due to pneumonia
- septic shock
Pneumonia
What are the risk factors for milti-drug resistance pneumonia?
previous IV antibiotic use in past 90 days
Pneumonia
When should MRSA be empirically covered for hospital acquired pneumonia (HAP)?
- multi-drug resistant risk factors
- > 20% MRSA isolates
- high risk for mortality
Pneumonia
How is it decided whether a patient requires 1 or 2 antipseudomonal agents for hospital acquired pneumonia (HAP)?
- 1 antipseudomonal agent= no MDR risk factors, low risk for mortality
- 2 antipseudomonal agents (2 different classes)= MDR risk factors, high risk of mortality, gram stain with numerous gram negative bacilli, patients with structural lung disease
Pneumonia
What antibitoics may be used for MRSA coverage in hospital acquired pneumonia (HAP)?
VANCOMYCIN or linezolid
Pneumonia
What antibacterials can be used for Pseudomonal coverage?
- piperacillin/tazobactam
- cephalosporin
- carbapenems
- monobactams (penicillin allergy)
- fluroquinolones
- aminoglycosides (never used alone)
- polymyxins
Pneumonia
What is the duration of therapy for hospital acquired pneumonia (HAP)?
7 days
