LRI Exam 4 Flashcards
common pathogens for CAP
- Viral* (Most common)
- Streptococcus pneumoniae* (Most common bacterial cause)
- Haemophilus influenzae (less common than historically)
- Moraxella catarrhalis
- Mycoplasma pneumoniae
- Chlamydophila pneumoniae
- Legionella pneumophila
Who has a higher risk of CAP?
pts younger than 30 y/o
For CAP, if t has the following risk factors (chronic corticosteroids, severe bronchopulmonary disease, alcoholism, frequent antibiotic therapy) what are they more susceptible to?
- Enterobacteriaceae
- Pseud. aeruginosa
common pathogens for HAP / VAP
- Rarely due to viral or fungal pathogens in immunocompetent patients
- Enterobacteriaceae
- Pseudomonas aeruginosa
- Acinetobacter species (VAP)
- Stenotrophomonas maltophilia (VAP)
- Polymicrobial infection is especially common with ARDS
For HAP / VAP, if pt has the following risk factors (diabetes, head trauma, ICU admission, recent Abx, tobacco use), what are they more susceptible to?
MSSA/MRSA
For infleunza, we’re worried about development of secondary bacterial infection especially for high risk patients. What are those high risk patients?
- Young children
- Elderly >= 65
- Patients with chronic lung disease
What are some general risk factors for HAP / VAP?
- Severe underlying disease
- Preexisting pulmonary disease
- Prior surgery
- Intubation / Mechanical ventilation / Enteral feeding
- Exposure to IV antibiotics
Risk factors for MDR pathogens (MRSA, Pseudomonas) to cause HAP and VAP
Prior IV antimicrobial therapy in preceding 90 days
Additional risk factors for MDR VAP
- Septic shock at time of VAP
- ARDS preceding VAP onset
- Current hospitalization > 5 days before VAP onset
- Acute renal replacement therapy prior to VAP onset
timing of CAP
Happens before or within 48 hours of admission
timing of HAP
Pneumonia arising > 48 hours after hospital admission
timing of VAP
Pneumonia arising > 48-72 hours after endotracheal intubation
Who should receive antiviral treatment?
- Hospitalized patients with confirmed or suspected influenza*
- Children < 2 years*
- Adults >= 65 years*
- Pregnant women or post-partum (within 2 weeks of delivery)*
- People with chronic pulmonary (including asthma), cardiovascular (except hypertension), renal, hepatic, hematological (including sickle cell disease), neurologic, neuromuscular, or metabolic (including diabetes mellitus) disorders
- People with immunosuppression (including medication-induced or HIV infection)
- People < 19 years receiving long-term aspirin therapy o American Indians/Alaska Natives
- Morbidly obese (BMI > 40)
- Nursing home/long-term care residents
Who should receive antiviral prophylaxis?
- young children
- elderly > 65
- chronic lung disease
candidates for influenza vaccine
- > 50 years old*
- Chronic lung disease (e.g., asthma, COPD)
- Chronic renal, hepatic, CVD
- Diabetes
- Neurologic disease (e.g., spinal cord injury, seizures)
- Immunosuppression (e.g., HIV, malignancy)
candidates for pneumococcal vaccine
- > = 65 years old*
- Chronic lung disease (e.g., asthma, COPD)
- Chronic renal, hepatic, CVD
- Diabetes
- Immunosuppression (e.g., HIV, malignancy)
- Asplenic (functional/anatomical)
- Alcoholism
role of palliative therapies in the treatment of acute and chronic bronchitis
- managing cough
- managing other symptoms
What can you use for cough suppression in bronchitis?
- Antitussives: Dextromethorphan, benzonatate (local anesthetic)
- Antihistamines for cough associated with allergic rhinitis; if viral infection, probably not the best choice
- Bronchodilators
- NSAIDS associated with improved cough control with rhinovirus infection; helps decrease severity of the cough: Highly effective in decreasing inflammation; high doses such as IBP 600-800mg TID scheduled
role of antibiotics in the treatment of acute and chronic bronchitis
- No proven benefit in acute bronchitis
- Used in CHRONIC bronchitis (because they have trouble clearing the infection by themselves): Improves clinical outcome
Pneumonia Severity Index (PSI)
- Class I-II: outpatient treatment
- Class III: observation in ED; consider hospitalization
- Class IV-V: hospitalization indicated
