micro: pneumonia

Question 1

common causes for children 6 weeks - 18 years

Answer 1

viruses (RSV)

mycoplasma
C. pneumoniae
s pneumoniae

Question 2

common causes for adults 18-40 years

Answer 2

mycoplasma
C pneumoniae
S pneumoniae

Question 3

common causes for adults 40-65 years

Answer 3

mycoplasma
S. pneumoniae

H. influenzae
anaerobes
viruses

Question 4

common causes for elderly

Answer 4

S. pneumoniae

H influenzae
anaerobes
viruses

gram (-) rods

Question 5

atypical pneumonia

Answer 5

mycoplasma
legionella
chlamydia

Question 6

nosocomial

Answer 6

gram (-) rods
staphlococcus
anaerobes

Question 7

immunocompromised

Answer 7

staphylococcus
gram (+) rods
fungi
viruses
pneumocystis jiroveci (with HIV)
mycobacteria

Question 8

aspiration

Answer 8

anaerobes

Question 9

alcoholics/ IV drug users

Answer 9

S. pneumoniae
Klebsiella
staphylococcus

Question 10

cystic fibrosis (CF)

Answer 10

pseudomonas
Burkholderia
S. aureus
mycobacteria

Question 11

COPD

Answer 11

H. influenzae
moraxella catarrhalis
S. pneumoniae

Question 12

postviral

Answer 12

S. pneumoniae
Staphylococcus
H. influenzae

Question 13

neonates

Answer 13

group B streptococci (GBS)

E. coli

Question 14

recurrent

Answer 14

obstruction
bronchogenic carcinoma
lymphoma
Wegener's granulomatosis
immunodeficiency
unusual organisms (nocardia, coxiella burnetii, aspergillus, pseudomonas)

Question 15

outpatient CAP < 65 years
otherwise healthy
no antimicrobials within three months

Answer 15

pathogens:
- s pneumoniae, mycoplasma pneumoniae, c. pneumoniae, H influenzae, viral

treat:
- macrolide or doxycycline

Question 16

> 65 years or comorbitity (COPD, heart failure, renal failure, diabetes, liver disease, alcohol abuse)
or antimicrobial use within 3 months

Answer 16

pathogens:
-s pneumoniae, h influenzae, aerobic gram (-) rods (E. coli, enterobacter, klebsiella), staph aureus, legionella, viruses

treatment:
- fluoroquinolone or B -lactam plus macrolide

Question 17

CAP requiring hospitalization

Answer 17

pathogens:
- S. pneumoniae, H. influenzae, anaerobes, aerobic gram (-) rods, legionella, chlamydia

treatment:
-fluoroquinolone or antipneumococcal B-lactam + macrolide

Question 18

CAP requiring ICU care

Answer 18

pathogens:
-S pneumoniae, legionella, h influenzae, anaerobes, aerobic gram (-) rods, mycoplasma, pseudomonas

treatment:
-antipneumococcal B-lactam + either azithromycin or fluoroquinolone

Question 19

institution/ HAP > 48 hours
or in a long-term care facility > 14 days
or ventilator associated pneumonia

Answer 19

pathogens:
-gram (-) rods (including pseudomonas and acinetobacter), S aureus, legionella, mixed flora

treatment:

• extended-spectrum cephalosporin or carbapenem with antipseudomonal activity
• add an amino glycoside or a fluoroquinolone for coverage of resistant organisms (pseudomonas) until lab sensitivities identify the best single agent

Question 20

critically ill or worsening over 24-48 hours on initial antibiotic therapy

Answer 20

pathogen
-MRSA

treatment:
-add vancomyosin or linezolid; broader gram (-) coverage