Pneumonia Flashcards
MC bacteria in CAP
S. pneumonia
If a patient abuses alcohol and comes in for pneumonia what is a common etiological factor?
Klebsiella pneumonia
Aspiration patients: etiology
Pseudomonas aeroginosa
CF pt: etiology
Pseudomonas aeroginosa
Young adults: etiology
mycoplasma/chlamydia
Atypical CAP etiology
Mycoplasma pneumonia
HIV related pneumonia etiology
Pneumocystis Pneumonia (PCP)
TB etiology
Mycobacterium tuberculosis
How would you treat CAP as an outpatient w/ no comorbities?
Macrolides (Clarithromycin or Azithromycin) or Doxycline for 5-10 days
How would you treat CAP as an outpatient w/ comorbidies or abx tx within the past 3 months
Respiratory fluroquinolone (levofloxacin, moxifloxacin, gemifloxacin) -or- augmentin plus macrolide
(5-10 days)
How would you treat CAP as an inpatient (non-ICU)
Respiratory fluoroquinolone
-or-
Beta lactam (ceftriaxone or cefotraxime) w/ macrolide
(these are all IV)
Do you need to culture for outpatients?
No, broad spectrum abx usually cover it.
Treatment of anaerobic PNA & lung abscess
Clindamycin or augmentin
If lung abscess/empyema: above abx plus drainage
What do you see on CXR’s if a patient has HIV related pneumonia?
Ground glass infiltrates
If HIV pneumonia is caused by PCP then what is the treatment?
trimethoprim/sulfamethoxazole (bacitrin), steroids if hypoxic
Tx for 21 days and then prophylaxis tx is continued
What are typical findings on CXR in a patient with TB?
Ghon and Ranke complexes
What are the 4 major 1st line drugs used to treat TB?
- Isoniazid
- Rifampin
- Pyrazinamide
- Ethambutol
How would you go about treating a patient w/ TB? (HIV -)
6-9 month regimen
- ->2months: all 4 drugs
- ->4months: isoniazid & rifampin
How would you go about treating a patient w/ TB who is HIV + ?
They need to see a specialist
Physical Exam findings of CAP?
Fever Tachypnea Tactile fremitus + egophony Dullness to percussion Crackles/rales
What is included in the Point of Care Diagnostic Testing (POC)
Sputum gram stain
Urinary antigen tests (for Legionella species and S. pneumonia)
Rapid antigen testing for influenza
If you choose to get a blood culture for a PNA case then what procedures must be followed?
At least 2 sets from 2 separate needle sticks at 2 different sites
How would you treat a patient w/ CAP as an ICU inpatient?
Macrolide or resp. fluroquinolone PLUS an antipseudomonal B-lactam
Risk factors for HCAP
- Abx therapy in past 90 days
- Acute hospitalization for at least 2 days in preceeding 90 days
- Resides in nursing home
- Home infusion therapy w/in past 30 days
- Home wound care
- Family member w/ an infx involving MDR pathogen
- Immunosuppressed
