Pneumonia, Bronchiectasis, And Lung Abscess Flashcards
What are the categories of the pneumonia?
- Community-acquired (CAP)
- Health care-associated (HCAP)
—hospital-acquired pneumonia (HAP)
—ventilator-associated pneumonia (VAP)
What is health care-associated with current hospitalization for ___ hrs, or hospitalization for ____ hr in the prior ___ months, residence in a _____ home or extended-care facility, ________ therapy in the preceding 3 months
- current hospitalization for 48 hrs
- Hospitalization for 48 hr/2 days in the prior 3 months
- nursing home
- antibiotic therapy
Classic pneumonia presents as a lobar pattern and evolves through four phases. What are the four phases?
- Edema- proteinaceous exudates are present in the alveoli
- Red hepatization- erythrocytes and neutrophils are present in the intraalveolar exudate
- Gray hepatization- neutrophils and fibrin depostion are abundant
- Resolution- macrophages are the dominant cell type
What are the typical bacterial pathogens involved in CA-pneumonia( 5)
Gram positives: —s. Pneumonia —h. Influenza —s. Aureus Gram negatives: —klebsiella —pseudomonas aeruginosa
What are the atypical organism involved in CA-pneumonia(4)?
Mycoplasma Pneumonia
Chlamydia pneumonia
Legionella
Respiratory viruses ( influenza viruses, adenoviruses, human metapneumonvirus, RSV)
How does the clinical manifestations of pneumonia present?
Fever, chills, sweats, cough (either nonproductive or productive of mucous, purple the, or blood-tinged sputum), pleuritic chest pain, and dyspnea
—N/V, diarrhea, fatigue, headache, myalgia, arthralgia
How do you diagnosis pneumonia?
CXR: differentiate CAP from other condition
Sputum samples: >25 WBCs and <10 squamous epithelial cells er high
blood cultures: positive in 5-14% of cases
—should be performed in high risk pts (chronic liver disease)
Urine antigen tests: s. Pneumonia and legionella
PCR: nasopharyngeal swab, respiratory infections
Serology: IgM antibody can assist in the diagnosis
What are the two criteria to identify whether to hospitalize pt with pneumonia?
Pneumonia Severity Index (PSI)
CURB-65
What are the criteria for pneumonia severity index (PSI)?
Points are given for 20 variables, including age, coexisting illness, and abnormal physical and laboratory findings
Puts are assigned to one of five classes of mortality risk
What are the criteria for CURB-65?
Five variable are included: Confusion Urea > 7mmol/L Respiratory rate > 30/min BP, systolic <90 mmHg or diasystolic <60 Age > 65 yo
Score of 0: treated at home
Score of 2: should be hospitalized
Score of >3 require management in the ICU
What is the empirical antibiotic treatment for an outpatient?
- Previously healthy and no antibiotics in past 3 months
—macrolide: clarithromycin, azithromycin or doxycycline - Comorbidities or antibiotics in past 3 month
—fluoroquinoline, gemifloxacin, levofloxacin
—beta-lactate or amoxicillin
—or cefltriaxone, cefpodoxime, cefuroxime plus a macrolide - In regions with a high rate of “high-level” pneumoncoccal macrolide resistance
—use drugs from classic 2
What is the empiric antibiotic treatment in inpatients, non-ICU?
- Fluoroquinolone (moxifloxacin, or levofloxacin)
2. Beta-lactam (ceftriaxone, ampicillin, cefotaxime, ertapenem plus a macrolide
What is the empiric treatment for inpatient, ICU patient?
Beta-lactam (ceftriaxone, ampicillin-sulbactam or cefotaxime plus either azithromycin or a fluoroquinoline
What antibiotic should be added to patient with pseudomonas?
Antipseudomonal beta-lactam (piperacillin/tazobactam), cefepime, imipenem, meropenem plus either ciprofloxacin or levofloxacin
—plus aminoglycoside (amikacin or tobramycin plus azithromycin)
—plus antipneumoncoccal fluoroquinolone
What drugs should be when considering CA-MRSA?
Add linezolid or vancomycin
What are some of the complications of pneumonia?
Common in severe CAP-respiratory failure, shock and multi-organ failure, coagulopathy, and exacerbation of comorbid disease
—Lung abscess ( usually CA-MRSA or p. Aeruginosa); drainage
—pleural effusion
Highest hazard ratio in the _____ ______ days of mechanical ventilation for acquiring VAP?
The first 5 days
What 3 factor are important for the pathogenesis of VAP?
- Colonization of the oropharynx
- Aspiration of these organisms to the LRT
- Compromise of normal ost defenses mechanisms
How do we prevent VAP when the pathogenic mechanism is elimination of normal flora?
Avoidance of prolonged antibiotic course
How do we prevent VAP when the pathogenic mechanism is large-volume oropharyngeal aspiration around time of intubation ?
Short course of prophylactic antibiotics for comatose pt
How do we prevent VAP when the pathogenic mechanism is gastroesophageal reflux?
Postpyloric enteral feeding; avoidance of high gastric residuals, pro kinetic agents
How do we prevent VAP when the pathogenic mechanism is bacterial overgrowth of stomach?
avoidance of prophylactic agents that raise gastric pH;selective decontamination of digestive tract with non-absorbable antibiotics
How do we prevent VAP when the pathogenic mechanism is cross-infection from other colonized pts?
Hand washing, especially with alcohol-based hand rub; intensive infection control education; isolation; proper cleaning of reuse-able equipment
How do we prevent VAP when the pathogenic mechanism is large-volume aspiration?
Endotracheal intubation; rapid-sequence intubation techniques; avoidance of sedation;decompresssion of small-bowel obstruction
