LRTI

Question 1

What is the difference between CAP and HAP/VAP?

Answer 1

• CAP is pneumonia that developed outside the hospital or < 48 hours after admission
• HAP is pneumonia that developed > 48 hours after hospital admission
• VAP is pneumonia that developed > 48 hours after endotracheal intubation

Question 2

Which microorganism class is the most common pathogenic organism for CAP?

Answer 2

virus

Question 3

What are the most common bacterial pathogens for CAP?

Answer 3

• streptococcus pneumonia (GP)
• haeomophilus influenza (GN)
• mycoplasma pneumoniae (atyp)
• legionella pneumophila (atyp)

Question 4

What are the risk factors for MRSA?

Answer 4

• 2-14 days post-influenza
• previous MRSA infection/isolation
• previous hospitalization
• previous use of IV antibiotics

Question 5

What is the significance of getting a MRSA nasal PCR?

Answer 5

• The results can confirm that the patient does NOT have MRSA
• This would allow us to d/c abx that were only be using to cover MRSA

Question 6

Which pathogens are commonly seen in patients with recent antibiotic exposure?

Answer 6

• staphylococcus aureus
• pseudomonas aeruginosa

Question 7

What would dense lobar consolidation or infiltrates suggest on a chest X-ray?

Answer 7

bacterial origin

Question 8

What would patchy, diffuse, interstitial infiltrates suggest on a chest X-ray?

Answer 8

atypical or viral pathogens

Question 9

What are the major criteria for severe CAP?

If patients present with one of these, then they have severe CAP

Answer 9

• septic shock requiring vasopressors
• respiratory failure requiring mechanical ventilation

Question 10

What are the minor criteria for severe CAP?

If a patient presents with at least 3 of these, then they have severe CAP.

Answer 10

• Confusion/disorientation
• Respiratory rate > 30
• Uremia (BUN > 20 mg/dL)
• Multilobar infiltrates
• Platelets <100,000 (thrombocytopenia)
• Pao2/Flo2 <250 (rare)
• Hypothermia (<36 C)
• hypotension requiring fluids
• leukopenia (WBC < 4,000 cells/uL)

CRUMPPHHL

Question 11

What are the empiric therapy options for a healthy outpatient adult w/o comorbidities or risk factors for abx resistance?

Answer 11

• amoxicillin 1 gm PO Q8H
• doxycycline 100 mg PO BID

If macrolide resistance is < 25%, then azithromycin could be used. Macrolide resistance is too high most of the time.