Pneumonia and Healthcare-associated Infections

Question 1

What is a CURB score?

Answer 1

C - new onset confusion (abbreviated mental test score <8)
U - Urea > 7mmol/L
R - Respiratory rate > 30 breaths per minute
B - blood pressure. Systolic <90. Diastolic <60mmHg.
65 - Age > 65.

Question 2

What does the CURB score mean?

Answer 2

It correlates risk with mortality

It can help decide if a patient can be treated at home e.g. (0-1)

Or if a patient may need critical care support - Score 4-5

Question 3

Is the CURB score a reliable score?

Answer 3

Yes and no. It can have its limitations and can underestimate severity of pneumonia for example younger patients have greater reserve and may be normotensive.
It should be used in conjunction with a holistic assessment of severity of parameters such as:
- presence of hypoxia
- significantly elevated WCC
- multi lobular pneumonia
- evidence of organ failure
- immunosuppression

Question 4

What samples can be taken in CAP?

Answer 4

• sputum
• blood
• legionella urine antigen (pt with severe CAP, CAP during outbreaks and all pt with risk factors)
• pneumococcal urine antigen - mod-severe CAP

Question 5

What are the treatment differences between mild, moderate and severe CAP?

Answer 5

MILD - single ABX usually for 5/7
MOD - dual ABX usually for 7-10/7
SEVERE - dual ABX usually IV for 48 hours for max duration 7-10/7

Question 6

What is the target for first ABX given to a patient after presentation to hospital with CAP?

Answer 6

4 hours

Question 7

What bacteria is usually implicated in HAP?

Answer 7

pseudomonas aeruginosa

Question 8

What type of bacteria does ABX for aspiration pneumonia need to cover? And what ABX are usually used?

Answer 8

Anaerobic

co-amoxiclav, tazosin or quinolone + metronidazole.

Question 9

What organisms are typically impacted in cases of CAP?

Answer 9

streptococcus pneumoniae

haemophillus influenza

Question 10

What would indicate that a patient’s community acquired pneumonia is more severe than their CURB-65 score suggests?

Answer 10

AKI
hypoxia
immunocompromised
multiblobar pneumonia (shown on X-ray)

Question 11

Give three possible treatments for aspiration pneumonia that was acquired in the community?

Answer 11

co-amoxiclav
tazosin
levofloxacin + metronidazole

Question 12

Appropriate treatment for HAP > 5 days

Answer 12

tazosin