Pneumonia Lecture

Question 1

what is the criteria used to determine if a CAP patient should be managed inpatient vs. outpatient?

Answer 1

CRB-65

1 point: confusion (delirium)
1 point: RR greater than 30/minute
1 point: BP less than 90 systolic or less than 60 diastolic

0-1 manage at home
1+ inpatient management

Question 2

what is considered an automatic admission in a CAP patient?

Answer 2

hypoxia

Question 3

is ABX use in pneumonia empiric or no?

Answer 3

YES

Question 4

what are our two treatment options for CAP?

Answer 4

1) respiratory fluoroquinolone (levo, moxifloxacin, etc)

2) cephalosporin (ceftriaxone) PLUS a macrolide (azithyromycin)

Question 5

most common pathogens seen in CAP?

Answer 5

strep pneumonia
mycoplasma pneumonia
chlamydia pneumonia
respiratory viruses

Question 6

what are adjunct therapies we can use for pneumonia?

Answer 6

O2 if sats less than 90 percent

nebulized albuterol, duoneb prn dyspnea

steroids (only in critical illness where pathogen is NOT influenza virus or aspergillus)

Question 7

when would we consider doing a sputum culture for our patient with pneumonia?

Answer 7

only for non-resolving or atypical pneumonia

Question 8

is repeat imaging recommended when managing pneumonia?

Answer 8

NO – not if clinical improvement is observed

if you need it, may consider a CT to look for abscess and empyema

Question 9

what are some criteria that define HCAP?

Answer 9

1. IV therapy, woundcare within prior 30 days
2. living in a LTC facility
3. hospitalization in acute care hospital 2+ days in past 90 days

Question 10

pneumonia that occurs 48 hours or more after admission and did not appear to be incubating at the time of admission is termed what?

Answer 10

nosocomial pneumonia

Question 11

pneumonia that develops 48-72+ hours after endotrachial intubation is termed what?

Answer 11

ventilator associated pneumonia

Question 12

is treatment with ABX empiric in HCAP?

Answer 12

yes!

Question 13

what are a few risk factors that put you at risk for multidrug resistance?

Answer 13

1. ABX within past 90 days
2. current hospitalization of 5+ days
3. high frequency ABX resistance in community
4. immunosuppressive disease/tx
5. immunomodulating medications
6. severe septic shock

Question 14

what drugs are used empirically for HCAP patients WITHOUT risk factors for MDR pathogens?

Answer 14

ceftriaxone (cephalosporin) or levaquin (fluoroquinolone)

Question 15

what drugs are used empirically for HCAP patients WITH risk factors for MDR pathogens?

Answer 15

“triple antibiotic therapy”

1) zosyn
2) fluoroquinolone (cipro or levaquin)
3) vancomycin

all given IV

Question 16

how long is the typical HCAP length of treatment?

Answer 16

7 days

Question 17

when can you consider switching from IV to PO equivalents in your patient with HCAP?

Answer 17

only if excellent clinical response to IV therapy for 48-72 hours

Question 18

how do we manage aspiration pneumonia? what is added to the treatment?

Answer 18

clindamycin IV if hospitalization needed
if MDR risk – triple ABX therapy

PLUS:
keep patient strict NPO until speech therapy comes
modified barium swallow may be needed to better define dysphagia