Pneumonia

Question 1

which two pneumonias do you treat the same way?

Answer 1

Hospital-acquired pneumonia (HAP)

Healthcare-associated pneumonia (HCAP)

Question 2

what is the leading cause of death due to infection?

Answer 2

pneumonia

Question 3

most common pathogen for bacteria pneumonia

Answer 3

Streptococcus pneumoniae

Question 4

2nd most common cause of bacterial pneumonia

Answer 4

Mycoplasma pneumoniae

Question 5

common cause in young children and elderly for bacterial pneumonia

Answer 5

Moraxella catarrhalis

Question 6

if someone has very severe CAP what should you suspect. linked with necrotizing CAP

Answer 6

methicillin resistant staphylococcus aureus

Question 7

if you have a kid with pneumonia what is the typical cause?

Answer 7

viral (RSV, influenza, parainfluenza)

Question 8

risk factors for drug resistant strep pneumo

Answer 8

65 
antibiotic tx in the previous 3 months 
medical comorbidities
alcohlism
immunosupression

Question 9

risk factors for aspiration pneumo

Answer 9

dysphagia
changes in oropharyngeal colonization
GERD
decreased host defenses (problems with mucus, cough)

Question 10

if you aspirate oral conentets what should you be worried about w/ aspiration pneumo

Answer 10

Anaerboes

Question 11

if you aspirate gastric contents what organisms should you worry about

Answer 11

Gram - bacilli and staph aureus

Question 12

risk factors for HAP

Answer 12

intubation and mechanical ventilation
aspiration
oropharyngeal colonization
hyperglycemia (promote infection)

Question 13

when are risks of VAP the highest?

Answer 13

1st 5 days after intubation high morality

Question 14

what organisms are common with HAP

Answer 14

aerobic gram - bacteria
gram positive bacteria (MRSA)
anaerobes are rare

Question 15

if your patient is admitted for pneumonia what must you get within 24 hours of admission

Answer 15

blood cultures

Question 16

tx for healthy outpatient pneumo CAP

Answer 16

macrolide of doxycycline

Question 17

tx for outpatient at risk for DRSP CAP

Answer 17

respiratory fluoroquinolones OR

beta-lactam + macrolide

Question 18

Tx for inpatient, non-ICU pneumo CAP

Answer 18

Respiratory fluoroquinolones OR

beta-lactam + macrolide

Question 19

DRSP means what

Answer 19

drug resistant strep pneumo

Question 20

Beta-lactams to choose from?

Answer 20

Ceftriaxone, cefotaxime, ampicillin/sulbactam

Question 21

what are respiratory flurorquionolones

Answer 21

Levofloxacin, moxifloxacin, gemifloxacin

Question 22

CAP Tx for inpatient ICU penumo

Answer 22

beta-lactam + azithromycin OR

beta-lactam + fluoroquinolone

Question 23

If you are worried about MRSA with pneumo what do you add?

Answer 23

Vacomyocin or linezolid

Question 24

what are antipneumococcal quinolones

Answer 24

Ciprofloxacin (also covers pseudomonas)

Levofloxacin (also in respiratory quinolones)

Question 25

duration of therapy for CAP

Answer 25

5-7 days longer with S. aureus, Pseudomonas

Question 26

Tx of aspiration of pnemo (oral contents)

Answer 26

PCN G
ampicillin/sulbactam
clindamycin
all cover typical pathogens

Question 27

tx of aspiration pneumo (oral and gastric conentes)

Answer 27

Ampicillin/sulbactam
amoxicillin/clavulante
piperacillin/tazobactam

Question 28

organisms for concern with HAP

Answer 28

MRSA
Pseudomonas aeruginosa
Acinetobacter spp.,
Stenotrophomonas maltophilia

Question 29

early onset HAP (<5 days) is most common by what?

Answer 29

S. pneumoniae
H. influenzae
MSSA
enteric gram (-) bacilli

Question 30

Tx for early onset HAP

Answer 30

3rd generation cephalosporin + macrolide

or respiratory flurorquinolone

Question 31

tx for VAP not at risk for MDR (multi drug resistant) pneumo

Answer 31

Cefotaxime OR
ceftriazone OR
ampicillin / sulbactam OR
antipneumococccal fluoroquinolone
 \+ vanco or linezolid (if high rates of MRSA)