Pneumonia Flashcards
What is the main treatment modality in Pneumonia?
Empiric Antibiotic Treatment.
Our diagnostic testing of etiology isn’t effective and is expensive.
What are the 3 categories of Pneumonia?
Community Acquired Pneumonia
Atypical Pneumonia (no way to distinguish)
Healthcare assoc. pneumonia
Who is most likely to contract pneumonia?
Males
African Americans
What are predisposing factors for Community Acquired Pneumonia?
Altered Level of Conciousness (aspiration of mouth contents during unconciousness) Smoking (dec cilia) Alcohol (dec LOC) Hypoxemia (decreases cilia) Acidosis Pulm Edema Uremia Malnutrition Immunosupression Age >65 Denture use while sleeping CF, bronchiectaisis, Kartagener's (dec cillia action) Dysphagia HIV
What are the most common Bacteria that cause Typical Pneumonia?
Strep Pneumo**, Haemophilus Pneumonia Staph Aureus Group A strep Moraxella Catarrhalis Anaerobes Aerobic G- Org
What are the most common bacteria that cause Atypical Pneumonia?
Mycoplasma Pneumonia, Legionella
Chlamidia pneumoniae
Chlamidia psittaci (rare from parrots)
What Bacteria is someone more likely to be infected by if they have influenza, previous Abtx or Lung disease?
Staph Aureus
Enterobacteriaceae
Pseudomonas
What are the risk factors for being infected with an anaerobic organism?
Aspiration associated with Altered LOC
causes lung abcesses and empyema
Less common Pts without teeth
How is pneumonia diagnosed?
Chest X-ray (infiltrates seen)
S and S of cough, FEVER, pleuritic chest pain (localized, extreme pain made worse with inspiration), dyspnia, sputum production
WHat is seen on CXR in pneumonia?
Lobar or interstitial Infiltrates or cavitation
film may be negative until Pt is well hydrated
Air/Fluid level charicteristic of a lung abcess
In what cases is ID of the specific organism considered critical?
Legionella
Influenza A/B and MERS
Community acquired MRSA
Agents of bioterrorism (Anthrax)
What are the diagnostic studies used for specific diagnosis of orgainisms in pneumonia?
Sputum and blood culture
Antigen detection for legionella and Strep Pneumo
PCR
In what cases is sputum gram stain and culture recommended?
ICU admission Failure of Abtx Cavitary changes on imaging Immunocompromised host Alcoholism Severe COPD Pleural Effusion Epidemic Pneumonia Epi data suggests resistance
Only usefu if an acceptable sample can be obtained
What is the difficulty of obtaining a blood culture?
Often contaminated with Staph normally found on skin
What is the Tx for pneumonia in low risk Pts?
Oral Macrolide
Azithromycin, Clindamycin, Erythromycin
OR
Doxycycline
