Pneumonia Flashcards
Components of CURB65 score
Confusion
Urea
Respiratory rate
BP
Age
Urea cut off for CURB65
> 20 mg/dl
RR cut off for CURB65 score
30 or more
BP cut off for CURB65 score
< 90 systolic
< 60 diastolic
CURB65 score for admission to medical floor
2
CURB65 score for admission to ICU
3-5
Pneumonia severity index for admission to medical floor
70
Pneumonia severity index for admission to ICU
130
2 major criteria for severe pneumonia
Need for vent or shock requiring pressers
Non severe hospitalized CAP abx regimen
3rd gen ceph + macrolide
OR
Fluoroquinolone
Only 2 indications for anaerobic coverage
abscess or empyema
Severe hospitalized CAP abx regimen w/o risk factors for pseudomonas or MRSA
beta lactam + azithromycin or fluoroquinolone
Severe hospitalized CAP abx regimen with risk factors for pseudomonas or MRSA
Anti-pseudomonal beta lactam + fluoroquinolone + MRSA coverage
5 Risk factors for resistant GNR infections requiring double coverage
Recent IV abx (90 days)
Respiratory failure
Hospitalized more than 5 days
High local incidence of resistance
Immunosuppressed
Length of treatment for VAP/HAP that is not pseudomonas or MRSA
7-8 days
Length of treatment for VAP/HAP that is pseudomonas or MRSA
8-15 days due to high recurrence rate
Definition of HAP
Pneumonia after 48 hours of admission to the hospital
Definition of VAP
Pneumonia after 48 hours on vent
Is tracheal aspirate as good as bronch specimen for VAP specimen
Yes
Clinical criteria for VAP
New infiltrate AND
Clinical evidence of infection
Patient who does not meet both criteria for VAP is diagnosed with what
Ventilator associated tracheobronchitis
Does ventilator associated tracheobronchitis require antibiotics
No
2 requirements for diagnosis of empyema
Frank pus
And/or
Positive gram stain/culture
Requirements to label a parapneumonic effusion as complicated
pH < 7.20
Glucose < 60
LDH > 3x upper limit
Do parapneumonic effusions require drainage
No
Do complicated effusions and empyema require drainage
Yes
