Pneumonia Flashcards
Pneumonia defination
Acute infection of pulmonary parenchyma
Pneumonia defination
Acute infection of pulmonary parenchyma
CAP
Not hospitalized or hospitalized less than 48 hrs
HAP
Pneumonia after 48 hrs of hospitalization
VAP
arises 48 hrs after endotracheal intubation
Contagious
Aspiration of bacteria
Inhalation of aerosolized droplets
Hematogenous spread
Direct enocultaion
Complication
Septicemia
Bacteria
Lung abscesses
Emyempa effusion
Symptoms
High fever
Chills
Cough with sputum or phlegm
SOB
pleuritic chest pain
Nausea vomiting
Low blood pressure
Outpatient CAP pathogens
S. Pneumonia
M.catarrhalis
M.pneumonia
S.aureus
H.influenzae
Respiratory viruses including influenza and COVID
Non ICU patient
Possibility of gram negative bacilli in addition to above
Inpatient ICU
S. Pneumonia
S aureus including MRSA
H.influenzae
Legionella spp
Enterobacteriales
VAP AND HAP
S.aureus MRSA
P.aeroginosa
Lab findings or diagnostics
X ray gold standards
CT
MRI
Culture and sensitivity for severe cases
PSI and Curb-65 to determine hospitilizations - mortality and morbidity
Admit patients PSI more than 71
CURB 65
Confusion,
Uremias,
RR> 30 breaths per min
BP <90/60
Age> 65 or more
COPD
Increases risk of infection from H.influenzae possible Pseudomonas
Goals
Eradicate pathogen
Signs and symptoms
Prevent complications
Minimize side effects
Narrow a/bs for shortest duration possible
General considerations
Use of empirical therapy
Local resistance patterns
Once pathogen has been identified change to targeted therapy
Symptoms usually improve after 3 to 5 days
Treat infection for 5 to 7 days ( at least patient should have no fever for 72 hrs considered clinically stable
Multi drug resistance if DRIP score more than or equals to 4
Major risk
Abs within 60 days
LTC residents
NG:Og feeds
Hx Of MDR pneumonia in last year
Major risk
Abs within 60 days
LTC residents
NG:Og feeds
Hx Of MDR pneumonia in last year
Minor risk
Hospitalizations within 60 days
Pulmonary disease
Poor functional status
H2RA PPI in last 14 days
Empiric Therapy for CAP OUTPATIENT NO MODIFYING FACTORS
Amoxicillin
Doxycycline
Macrolide azith or Clarith
CAP outpatient with modified factors means
Immunologic
Respiratory
Circulatory
Rheumatologic
Hepatic or renal
Endocrinology
Beta lactams
Amoxi clav or sec gen cephalosporin
+
Macrolide or doxycycline
Or
Respiratory floroquinolones
Inpatient Non-ICU
Respiratory FQS
Beta lactam IV or PO
ceftriaxone ceforaxime ir Amoxi clav + Macrolide
For children
IV ampicillin or po amoxicillin
ICU
Third gen cephalos IV and azithromycin IV or FQ IV
Inpatient ICUs pseudomonas suspected
Anti pseudomonas’s pip-tazo, cefipime, meropenem, ceftazidime + Cipro or levofloxacin
Anti pseu beta lactams +!aminos+ azithro
CAP
S pneumonia pen/ amoxi/ cefotaxime or ceftriaxone
H inf amoxi:clav
M catarrhalis 2nd or 3rd generation
Mycoplasma Macrolide doxycycline FQS
Legionella azith fqs and doxys
MSSA cloxacillinIV /cefazolin / cephalexin
MRSA vancomycin or linezolid
