Pneumonia Flashcards
Pneumonia is an acute infection of the ____________
Pulmonary parenchyma
The three different kinds of pneumonia are
1.
2.
3.
- CAP
- HAP
- VAP
Community acquired pneumonia is pneumonia in a patient not hospitalized or hospitalized for less than ___ hours
48
List two complications of pneumonia
- bacteremia
- sepsis / septic shock
- empyema
- lung abscess
List 3 common symptoms of pneumonia
- Fever
- Chills
- Cough
- SOB
- Chest pain
What are the common community acquired pneumonia (CAP) pathogens as an OUTPATIENT
Respiratory Viruses
S. pneumoniae
M. catarrhalis
C. / M. pneumoniae (Atypical)
S. aureus
H. influenzae
What are the common community acquired pneumonia (CAP) pathogens as an INPATIENT (NON-ICU)
Outpatient pathogens +/- gram negative bacilli
What are the common community acquired pneumonia (CAP) pathogens as an INPATIENT (ICU)
S. pneumoniae
S. aureus (including MRSA)
H. influenzae
Legionella spp.
“PAIL”
What are the common hospital acquired (HAP) and ventilator acquired (VAP) pathogens
S. aureus (including MRSA)
P. aeruginosa
S. pneumoniae (less common)
enteric gram negative bacilli
The pneumonia severity index (PSI) and CURB-65 scores are used to determine the probability of _____ and _____ in patients with pneumonia
morbidity and mortality
A curb65 score of 2 or more means the patient should be:
admitted to the hospital
List some common risk factors for CAP
Very young or very old
immunocompromised
underlying diseases (DM, CHF, COPD)
When starting empirical therapy for pneumonia, patients who have received an antibiotic in the past 3 months should be given an agent from a ___________ class of antibiotics in order to minimize the risk of treatment failure due to antimicrobial resistance
different
Empiric therapy of CAP
Outpatient (no modifying risk factors)
“ADAM”
Amoxcillin (children and adults)
Doxycycline
Macrolide (azithro or clarithro) *if rate of resistance is <25%
Empiric therapy of CAP
Outpatient (WITH modifying risk factors)
Beta-lactam (amox/clav or 2nd gen cephalosporin) + macrolide/doxy
Respiratory FQ
Inpatient therapy of CAP
NON-ICU
Respiratory FQ
Beta-lactam (ceftriaxone, cefotaxime, or amox/clav) + macrolide
Inpatient therapy of CAP
ICU
Beta-lactam IV + (FQ IV or azith IV)
Inpatient therapy of CAP/ ICU
Pseudomonas suspected
Antipseudomonal beta-lactam + Ciprofloxacin or Levofloxacin
= pip-taz, cefepime, meropenem, ceftazadime
Antipseudomonal beta-lactam + AG + IV azithromycin
Empiric therapy for HAP or VAP
Stable (low risk) patient / No MRSA
Pip-taz
Cefepime
Levofloxacin
Meropenem
Imipenem
Empiric therapy for HAP or VAP
Stable (low risk) / possible MRSA
Pip-taz
Cefepime
Levofloxacin
Ciprofloxacin*
Aztreonam*
Meropenem
Imipenem
MRSA coverage
Vanco
Linezolid
Empiric therapy for HAP or VAP
Unstable / High risk (ventilated or septic shock) / IV Abx Exposure
Severe HAP/ALL VAP
Pip-taz
Cefepime
Meropenem
Imipenem
Aztreonam
—————-
Levo
Cipro
AG
————–
MRSA coverage
Vanco
Linezolid
Severe always have double coverage pseudomonas + MRSA coverage
Targeted Therapy for CAP
S. pneumoniae= _______, _________, cefotaxime, ceftriaxone
H. influenzae = _________, 2nd/3rd gen cephalosporins, amox/clav
M. catarrhalis (Always produce beta lactamase) = __________, ___________
M. pneumoniae/C. Pneumoniae=
Legionella spp =
MSSA = ________, cefazolin, cephalexin
MRSA = Vancomycin, Linezolid, and NOT _______
S. pneumoniae= Pencillin, Amoxicllin, cefotaxime, ceftriaxone
H. influenzae = Amoxcillin, 2nd/3rd gen cephalosporins, amox/clav
M. catarrhalis (Always produce beta lactamase) = 2nd/3rd gen cephalosporin, amox/clav
M. pneumoniae/C. Pneumoniae= FQ, Macrolides, Tetracyclines
Legionella spp = FQ, Macrolides, Tetracyclines
*these two are atypical, lacking cell wall, so only these classes will provide coverage
MSSA = cloxacillin (IV), cefazolin, cephalexin
MRSA = Vancomycin, Linezolid, and NOT DAPTOMYCIN because it is inactivated by pulmonary surfactant, rendering it ineffective
Total duration of therapy for CAP is between __ and ___ days
5 and 7
Total duration of therapy for HAP/VAP is __ days and longer (__ to __) days in certain cases
7 days 10-14
For pneumonia treatment, it is OK to use/change to PO therapy when the patient is _____
STABLE
- tolerate oral
-afebrile for 48-72h
-hemodynamically stable
- improving oxygenation
