Pneumonia Flashcards
What is the globla % of deaths caused by pneumonias
7%
What is the gold standard for diagnosing of pneumonia
New consolidation on CXR
What is the genearl incidence of pneumonia
5-11 per 1000
40% need hospitalising –> of these up to 14% mortality
What are hte most common cause of pneumonia
Strep Pneumonia (36%)
H. Influenzae (10.2%)
In almost 50% no oragnism is idneetified
What are common causative organisms in COPD
H. Influenzae and M. Cattarhalis
What are common causative organisms in Aspiration
Gram -ve bacilli and anaerobes
What are common causative organisms in nursing homes
S. Aureus and aspiration
What are common causative organisms in diabetes
Bacterial pneucomococcal
What are the pathogenesis of S. Pneumoniae
Few toxins –> pneuloysin is most imporatnt
Causes marked host inflammatory response –> tissue damage
What percentage of us are colonised by s. pneumoniae
5-10%, but increases in winter
What is the role of the spleen in protecting against s. pneumoniae
Protects against enapsulated s. pneumoniae –> if asplenic give abx prohophylaxis
What is the first line for CAP
Amoxicillin –> however increasing resistance is being seen in S. pneumoniae
How is resistance to macroldes being seen in CAP
ermB- altered binding pocket at ribosome
ermA - efflux pump
What type of organisms is H . influenzae
Gram -ve cocco-bacilli, encapsulated or non-encapsulated
What % of H. Influenzae produce beta-lactamase
20%
When do you generally get s. aureus pneumonia
FOllowing infleunca
Who is M. catarrhalis pneumonia more common in
Those with underlying chronic lung disease e.g. COPD
Who is enterbactericeae more common in
More common in elderly
May get haemorrhogic pneumonia
What may make you think its an atypical pneumonia
Doesnt respond to beta lactams
unusualy appearance on CXR –> i.e. patchy shadowing rather than lobar consolidation
Fastidious organism –> difficult to grow
What do we give to cover atypical pneumonia organisms
A macrolide i.e. clarithromycin
Who does mycoplasma usually affect
Young males
Incubation and symtpomas of mycoplasma
2-3 week incubation; flu-like prodrome followed by pneumonia
Usually mild disaese with a more dramatic CXR than clinical picture
Epidemics occur every 3-4 years
May get immune problems following e.g. SJS
What type of organism is Legionell
Gram -ve coccovacilli
How do you get legionella
Naturally lives in water –> acquired via the inhalation of contaminated aerosols
Outbreaks in hospitals a hotels
Espescially occurs in summer due to prfering tepid water and people hliday
What are the advancatges of reaching a microiological diagnosis
Enables the use of more narrow spectrum agents
Decreases the devlopment of resistance
May enable pathogen idenfications
Epidemiological reasons
What are the methods of microbiological diagnosis
Blood Culture
Sputum Culture
Bronchoscopy
Urinary antigen detection
What is the precalince of HAP
0.5-1% of patients
VAP has a mortality of up to 75% if due to an MDR organisms
What are risk factosr for HAP
Sedation Intubation Poor cough reflex Long term hospital stay Vomiting Impaired swallowing
What are the causes of early onset HAP
community organists
What are the causes of late onset HAP
1) Gram -ve fermenters e.g. gut commensal –> E. Coli etc
2) Gram -ve non-fermenters e.g. P. Aureginosa and Acinetbacter
3) Gram +ves, S. aureus
4) Others: Anaerobes, Legionalla, Virsues
Why can endotracheal tube placement cause problems
Local trasuma can increase coloinisation and decrease bacterial clearance
Secretions can pool and leak into the LRt and the ET cuff
Inhalation of contaminated aerosols
Biolfilm formation
Bacteria transported to LRT during swalloing
What infection control measures can we do to prevent pneumonia
Screening swabs Side Rooms Hand Washing Cleaning of Equipment PPE barrier nurse Screen other patients Dedicated Nurse
Preventative measure of pneumonia for VAP
Disinfection of equipment
No routine chanigng of equipment
Sterile insertion and suctioning
Nurse head up to prevent secretions pooling
‘Sedation canvations’
Extubate ow wean as soon as clnically safe
Selective decontamination –> controversial
