Pneumonia Flashcards
Define HAP
Pneumonia in person 48 hours after admission and not suspected to be incubating at time of presentation
Results of individual patient data review meta-analysis for steroids in pneumonia
No improved mortality
More insulin required, shorter stay
More likely to have readmission for CAP
CXR vs. CT - concordance for pneumonia
only ~40% of patients with pneumonia on CT had CXR changes
Only 26% of CXR that were reported as having opacities had opacity on CT
Define atypical pneumonia
negative gram stain
no response to penicillin
**clues include abnormal LFTs and GIT symptoms
Define CAP
Pneumonia in someone not meeting criteria for HAP or VAP
What are the causes of atypical pneumonia? (6)
Non-zoonotic Chlamydia pneumophila Mycoplasma pneumoniae Legionella sp Zoonotic Coxiella brunetti (Q fever) Chlamydia psittaci (psittacosis) Francisella tularensis (northern hemisphere)
What does a CURB65 score of 3-5 entail? (30 day mortality and management)
30 day mortality 22%
Admit and treat as severe CAP
What does PSI score <130 entail?
27% 30 day mortality
Define VAP
Pneumonia whose onset is 48 hours after initiation of endotracheal intubation
Are steroids indicated in treatment of pneumonia?
Unclear but probably not
What is the major risk factor for pseudomonas infection with respect to pneumonia?
ICU stay
What percentage of CAP has a microbial diagnosis?
45% (55% do not have microbial diagnosis)
What is the rate of pneumococcal resistance to doxycycline?
20%
What does a CURB65 score of 0-1 entail? (mortality, suggested management)
30 day mortality is 1.5% with suggested home management
What does a CURB65 score of 2 entail? (30-day mortality and suggested management)
30 day mortality of 9.2% and suggested admission to hospital
Which patients with pneumonia should get blood cultures?
Only those with severe pneumonia
What is the magnitude of increased cardiovascular risk for the 12 months following S. pneumoniae CAP?
3-5 fold higher risk, particularly of arrythmias (due to microlesions incorporated into myocardium)
What are the most common bacterial causes of pneumonia? (5)
S. pneumo 14% Mycoplasma pneumoniae 9% Haemophilus influenzae 5% Legionella sp. 3% Moraxella catarrhalis 1%
What does PSI score <70 entail?
0.6% 30 day mortality
Pneumonia “red flags” (7)
RR>25 Sats <92% on r.a. Multilobar SBP<90 Acute confusion HR>100 Serum lactate >2
What is an appropriate step down from IV Augmentin?
Augmentin DF (1 tab, BD) plus Amoxicillin 1g midi
Cochrane review of steroids in pneumonia
Suggested mortality benefit with NNT of 18
What are the parameters for CURB65?
Confusion Urea>7mmol/L Respiratory rate >30 BP (SBP <90, DBP <60) Age>65
