Pneumonia Flashcards
Most likely bacteria in CAP for alcoholics
S. pneumoniae anaerobes
4 most likely bacteria in CAP for COPD and/or smoking
- S. pneumoniae
- H. influenzae
- M. catarrhalis
- Legionella
Most likely bacteria in CAP for SNF residents
S. pneumoniae
Gram negative bacilli
H. Influenza
S. aureus
anaerobes
C. pneumoniae
Most likely bacteria in CAP for poor dentition
Anaerobes
Most likely pathogen in CAP if exposed to bats or soil with bird droppings
Histoplasma
Most likely pathogen in CAP if exposed to birds
Chlamydia psittaci
Most likely pathogen in CAP if exposed to rabbits
Francisella tularensis
Components of CURB-65 score
- Confusion (new onset)
- Urea > 7
- Respirations > 30
- BP < 90 systolic or 60 diastolic
- Age 65 or greater
CURB-65 score treatment decisions
- 0 to 1
- < 3% 30 day mortality
- Outpatient care
- 2
- 9% risk 30 day mortality
- Hospital ward
- 3 to 5
- 15-40% risk 30 day mortality
- Inpatient care, possible ICU
ATS/IDSA major criteria for severe pneumonia
- Requirement of mechanical ventilation
- Septic shock
ATS/IDSA minor criteria of severe pneumonia
- Must have 3 or more
- respirations > 30
- Confusion
- Uremia (BUN > 20)
- Leukopenia (< 4)
- Systolic BP < 90
- Multilobar infiltrates
- PO2/FIO2 ratio < 250
- Thrombocytopenia (< 100k)
- Hypothermia (< 36 C)
- Hypotension requiring fluid management
3 serotypes of S. pneumoniae associated with mechanical ventilation
Serotype 3
Serotype 19A
Serotype 19F
Which serotype of S. pneumoniae is associated with septic shock
Serotype 3
Emperic antibiotic regimen for CAP on the hospital ward
beta lactam + macrolide
OR
Respiratory fluoroquinolone
Empiric antibiotic regimen for CAP in ICU
Beta lactam + Macrolide
OR
Beta Lactam + fluoroquinolone
What preventative measure has been shown to reduce mortality in VAP?
Selective digestive decontamination
Can VAP be diagnosed on clinical criteria alone or should additional tests such as CRP or procalcitonin be used
Clinical criteria alone
Coverage for VAP should include what 3 pathogens
S. aureus, pseudomonas, and gram-negative bacilli
Criteria for 2 drug pseudomonal coverage
- VAP (not HAP) with any of the following
- A risk factor for resistance
- If ICU has > 10% resistant to the drug being used
- If local susceptibility rates are not available
- High risk of mortality
5 Risk factors for MDR VAP
Prior IV antibiotic use in the last 90 days
Septic shock at the time of VAP
ARDS preceding VAP
5 or more days of hospitalization prior to VAP
Acute RRT prior to VAP
6 Beta lactams with anti-pseudomonal activity
- Zosyn
- Cefepime
- Ceftazidime
- Imipenem
- Meropenem
- Aztreonam
7 Non-beta lactams with antipseudomonal activity
- Ciprofloxacin
- Levofloxacin
- Amikacin
- Gentamycin
- Tobramycin
- Colistin
- Polymyxin B
First line choice for empiric treatment of ESBL pathogens
Carbapenems
First line treatment for Acenitabacter HAP/VAP
Carbapenem
Ampicillin/sulbactam
Regimen for carbapenem resistent pathogens
IV polymixin (either colistin or polymyxin B)
AND
Inhaled colistin
Duration of treatment for HAP
7-8 days
Treatment for pulmonary tularemia
Streptomycin
Treatment for cryptococcus in transplant patients
Amphotericin and flucytosine until 2 weeks culture negative
then
8 weeks high dose fluconazole
then
1 year of low dose fluconazole
