Pneumonia Flashcards
What are some of the typical organisms that cause CAP?
- Strep pneumoniae
- H.influenzae
- Staph. aureus
When is staph aureus pneumonia most common?
- at extremes of age in individuals recovering from influenza
What are some of the atypical organisms that cause CAP?
- mycoplasma pneumoniae
- chlamydophila pneumoniae/psittaci (from parrots)
- legionella
- influenza
What percent of CAP is caused by viruses?
- 15%
What are some causes of hospital acquired pneumonia?
- gram neg enterobacter (most common)
- staph aureus
- pseudomonas (bronchiectasis and CF)
- klebsiella
- bacteroides
- clostridia
Define HAP
pneumonia acquired 48 hours or more after admission
When should HAP be suspected?
In pts with new or progressive infiltrate on CXR as well as clinical characteristics:
- fever (>38T)
- purulent sputum
- leukocytosis
- decline in oxygenation
What are the risk factors for aspiration pneumonia?
- stroke
- bulbar palsy
- myasthenia gravis
- decreased consciousness (drunk, post-ictal)
- oesophageal disease (achalasia, reflux)
- poor dental hygiene
What are the main microbes associated with aspiration pneumonia?
oropharyngeal anaerobes
What is the pathophys of consolidation?
suppurative inflammatory exudate in airways which may be patchy consolidation or lobar consolidation
What is the pathophys of interstital pneumonia?
- lymphocytes and macrophages in the alveolar septa
- lung involvement patchy
- alveoli usually free from exudate
- may also be caused by drugs or be autoimmune
What are the symptoms of pneumonia?
- acute onset cough \+/- purulent sputum - fevers - rigors - malaise - anorexia - dyspnoea, - haemoptysis, - pleuritic chest pain
What are the signs of pneumonia?
- pyrexia
- cyanosis
- confusion
- tachypnoea
- hypotension
- decreased expansion
- bronchial breathing
- dull percussion note
- vocal fremitus
- pleural rub
What are the important investigations to be performed?
- CXR
- sputum M/C/S
- blood cultures
- ABGs
- FBE, U&E, CRP, LFTs
How should pneumonia be managed?
- oral antibiotics if not severe
- oxygen
- IV fluids if dehydrated or in shock
- VTE prophylaxis
- analgesia if pleurisy
- consider ICU if hypoxic, hypercapneoic or shock
At what level should oxygen sats be maintained at?
- 94-98% or PaO2>60mmHg
- 88-92% in COPD
Empiric treatment for CAP?
amoxicillin or doxycycline
Empiric treatment for moderate CAP?
oral amoxicillin and clarithromycin or doxycycline
Empiric treatment for severe CAP?
Co-amoxiclav IV or cephalosporin IV AND clarithromycin AND flucloxacillin if staph suspected
- treat for 10 d
Empiric treatment for atypical pneumonia?
- fluoroquinolone for legionella
- tetracycline for chlamydophila
- co-trimoxazole for p.jirovecii
Empiric treatment for HAP?
aminoglycoside IV + antipseudomonal penicillin IV or 3rd gen ceph IV
Empiric treatment for aspiration pneumonia?
cephalosporin IV + metronidazole IV
How is the severity of pneumonia determined and what do the scores mean?
"CURB-65" - confusion - urea >7mmol/L - RR >30 - BP (systolic) 65 y Score: 0-1 treat at home, 2 = hospital therapy, 3 or > = consider ICU
What vaccinations can be given to prevent some types of pneumonia?
- 23-V pneumococcal vaccine
- annual influenza
