Pneumonia Flashcards
What are the risk factors for contracting pneumonia?
Alcohol abuse
immunosuppressed
lung disease
over the age of 70
institutionalized
What are the ways a pneumonia infection can occur and order them in increasing occurrence?
Hematogenous spread
Inhalation of airborne particles
Aspiration of oropharyngeal material (Most common)
What respiratory defenses do we have?
hair, cilia, mucous, salivary enzymes, macrophages, antibodies and epithelial linings
In what ways can our defense systems be compromised?
alcohol, smoke, disease, viruses, and oxygen levels. These change the number of microorganisms and increase the chance for them to cause problems.
What are the most common causes of CA pneumonia?
S. pneumoniae=30-60%
H. infuenzae= 2-20%
S. aureus= 1-5%
M. pneumoniae= 5-10%
VIRAL TOO- 2-15%
What are the organisms that cause atypical pneumonia and why?
M. Pneumonia- infects more than one lobe, doesn’t grow on agar
Chlamydiae and legionella- infect more than one lobe and don’t grow on agar
What are the common organisms that cause HA pneumonia?
K. pneumoniae, E. coli, Enterobacter= 60%
P.aeruginosa= 8-15%
S. aureus= 13%
Anaerobes= 20%
What are the signs and symptoms of pneumonia?
Fever >39 degrees
chills
dyspnea
cough
rust color sputum
pleuritic chest pain
tachycardia
tachypnea
What clinical tests can we do?
Chest x-ray-required for diagnosis
WBC count
Sputum culture- often contaminated(NO in CAP)
blood culture- not unless severe or if suspect aeruginosa or MRSA
Serology- look at antibody titre for a specific pathogen
What are the two algorithms for determining severity of pneumonia?
Pneumonia Severity Index
CURB-65
HOWEVER, regardless of score the patient needs to be able to take food orally, do daily activities, and comply with instruction
What are common goals of therapy for Pneumonia?
Eradicate the organism by day______
Resolve signs and symptoms
reduce risk of complications
minimize resistance
General non-pharmacological treatment for pneumonia?
rest
fluids, food
analgesic/antipyretics
oxygen
drainage
True or false: A patient should wait for their culture before starting antibiotics
FALSE
What antibiotics cover the top 3 pathogens (Strep, Haemophilus, Mycoplasma)
Amox- but resistance for H. influenxae
Azith- resistance for S. pneumonia
Levofloxacin will 100% cover all three.
What is the first-line treatment for Pneumonia?
Amoxicillin 1000mg TID
Doxycycline 100mg BID
Clarithromycin 500mg BID
Azithromycin 500mg first day then 250mg for 4 days
USE MACROLIDES IF RESISTANCE IS UNDER 25%
in saskatoon= about 26%
When should we worry about the potential for MRSA or P. aeruginosa?
Prior isolation of these species or recent hospitalization in the last 90 days.
also the local level of these organisms
What treatment do we give if a pneumonia patient has comorbidities?
Amox/Clav 500mg/125mg TID. OR
Cefuroxime 500mg BID. OR
Cefprozil 500 mg BID
AND
Clarithro, azithro, doxy
OR
Monotherapy of Levofloxacin or Moxifloxacin
What is the duration of treatment for CAP?
Minimum of 5 days and be afebrile for 48-72 hrs
azithromycin is 3 days
For MRSA or P. aeruginosa is 7 days
What is the specific treatment for S. Pneumonia?
Penicillin G
Penicillin V- high dose can overcome resistance
Amoxicillin- high dose can overcome resistance
Alt= Cefazolin, erythromycin or FQ
What is the specific treatment for S. Aureus?
MSSA= Cloxacillin 8-12 g/d ALT= cefazolin, clindamycin, vancomycin
MRSA= Vancomycin, linezolid
TREATMENT TAKES 14-21 DAYS
What is the specific treatment for H. influenza?
Non-B lactamase= Ampicillin 6-8 g/d, amoxicillin 3g/d
B lactamase= amox/clav, 2nd generation, 3rd generation, FQ, Doxy, azithro, clarithro
What is the specific treatment of aerobic Gram-negative rods?
3rd generation cephalosporin
carbapenem
piperacillin/tazobactam
What is the specific treatment of aerobic Gram-negative rods?
3rd generation cephalosporin
carbapenem
piperacillin/tazobactam
What is the specific treatment of P. aeruginosa?
piperacillin/tazobactam and cipro/AMG
Ceftazidime and cipro/AMG
Ciprofloxacin and AMG
Cefepime and cipro/AMG
meropenem and cipro/AMG
