LRTI (pneumonia)

Question 1

Identify the pathogens responsible for
1. outpatient + no comorbidities
2. outpatient + comorbidities
3. inpatient, non-severe
4. inpatient, severe

Answer 1

1. strep.pnuemo
2. • haemophilus influenzae + atypicals
3. • MRSA + pseudomonas
4. • Burkholderia pseudomallei + S.aureus

Question 1

What does it mean when the patient gets 4 points on CURB-65?

Answer 1

inpatient, mb ICU

Question 2

What is the difference in criteria to cover MRSA and pseudomonas in outpatient severe vs non-severe?

Answer 2

outpatient severe:
MRSA, pseudomonas
1. hospitalised in past 90 days
2. IV abx for past 90 days
3. found in respi in past year
outpatient non-severe:
MRSA: - (hospitalised/ IV abx in past 90 days) AND mrsa PCR +ve
- found in respi past year
pseudomonas: found in respi in past year

Question 3

What are the 8 minor criteria in IDSA/AST risk stratification criteria?

Answer 3

CUR
Pao2/FiO2 <250
new infiltrates
<36C
WBC<4x10^9
hypotension req fluid resuscitation

Question 4

What are the 3 major criteria for IDSA/AST stratification criteria for inpatient severity?

Answer 4

req mechanical ventilation
req vasoactive meds
septic shock

Question 5

What abx wld you give for outpatient with no comorbidities?

Answer 5

amox
pen allergy: respi FQ

Question 6

What abx wld you give for outpatient with diabetes?

Answer 6

strep. pneu and haemo. influenzae: amox-clav/ cefuroxime/ ceftriaxone
+ atypicals: macrolides (clarithro/azithro)/ doxycycline

OR respi FQ

Question 7

Pneumonia abx for MRSA

Answer 7

vanco, linezolid

Question 8

abx that cover pseudo

Answer 8

pip-tazo, , ceftizidime, cefepime, meropenem, amikacin, levo

Question 9

whats the only abx that covers burkholderia pseudomallei

Answer 9

ceftazidime

Question 10

causative bacteria for HAP/VAP (minimally these must be covered)

Answer 10

pseudomonas, S,aureus, enterobacterales

Question 11

criteria for MRSA cover in HAP

Answer 11

> 20% of staphs are MRSA
IV abx past 90 days
hospitalised past 90 days

Question 12

when to DOUBLE cover pseudomonas

Answer 12

> 10% of pseudo is resistant against monotherapy
high risk of mortality (septic shock)
IV abx past 90days
hospitalised past 90 days

Question 13

What abx do you add if there is lung abcess?

Answer 13

(abcess -> anaerobes)
metronidazole, clindamycin

Question 14

Patient diagnosed with CAP has Sx of myalgia, headache, confusion what do you do

Answer 14

suspect influenza –> culture –> oseltamivir 75mg BD 5 days –> if culture -ve stop

Question 15

duration of treatment for CAP and HAP

Answer 15

CAP 5 days min, 7 days if MRSA/pseudo cover

HAP: 7 days