Puemonia Flashcards
Why are post surgical patients more at risk of puemonia?
Shallow breathing due to abdo pain
Why are patients in hospital at a higher risk of resistant bacteria causing infection? (2)
- Recent antibiotic exposure
- More resistant organisms in hospital environment
Why is hospital accquired pneumonia more difficult to diagnose? (3)
- Non specific (Low O2 sats/breathlessness could be another cause)
- Multiple sources of infection e.g catheter
- Chest x ray difficult to interpret - chronic changes?
What pathogens cause hospital accquired pneumonia? And which is the most typical?
- Multi drug resistant organisms e.g MRSA (most typical)
- Gram negative/bowel flora (klebsiella pneumoniae/escherichia coli)
- Environmental organisms (pseudomonas spp)
What does MRSA stand for?
Meticillin resistant staphyococcus aureus
Give 2 examples of bowel flora causing HAP and how do they cause it?
- Kebsiella pneumoniae
- Escherichia coli
Pathogens usually living in bowel colonising throat
Give an environmental organism that causes hospital accquired pneumonia. Where does it grow? (2)
Pseudomonas app
- Showerheads/taps
- Measured in hospital water supply
Under what criteria is pneumonia classified? (4)
- Community acquired: no recent hospital contact
- Hospital acquired: after 48 hours in hospital
- Ventilator associcated: after 48 hours of ventilation
- Aspiration: not time related = community/hospital = different cause (intrinsic)
What factors in patients are associated with aspiration pneumonia? (3)
- Reduced consciousness
- Dysphagia (stroke)
- Upper GI tract disorders : poor swallow e.g acid reflux
What factors in patients are associated with streptococus pneumoniae distinctly from other types of pneumonia? (3)
- Extremes of age
- Immunocompromised patients e.g HIV/diabetes/asplenic
- Family history: children spreading to grandparents
What factors in patients are associated with streptococus aureus distinctly from other types of pneumonia? (2)
- Young adults
- Post infuenza
What does strep aureus pneumonia tend to progress to?
Caviating pneumonia
What type and examples of symptoms are more common in mycoplasma pneumoniae? (4)
Extra-resp manifestations:
- Haemolysis: RBC breakdown (jaundice)
- Skin: erythema multiforme (hypersensitivity reaction to infection - round red/pink flat macules, backs of hand and tops of feet spread to trunk)
- Skin: Steven Johnsons syndrome (flu with maccule rash like targets on starting on trunk)
- Cardiac: pericarditus, myocarditus
What factors in patients are associated with leginella distinctly from other types of pneumonia? (3)
- Moderate - severe community accquired puemonia (sometimes hospital)
- Outbreak in hotels/nursing homes etc
- Failure to respond to antibiotics
What signs more common in legionella infections than other puemonias? (3)
- Low sodium
- GI symptoms
- Elevated ALT/AST
What factors in patients puts them at risk of hospital accquired puemonia? (3)
- Post surgical patients
- Chronic lung disease
- Aspiration risk factors
- Immunocompromised
How can the particular cause for puemonia be detected? (2)
- Indirect detection: complement fixation test
- Direct detection: PCR
What is a complement fixation test for the indirect detection of the cause of puenmonia?
Immunological test= detects presence of specific antibody/antigen in patient’s serum based on if complement fixation occurs
What is the advantage of using PCR for the direct detection of the puemonia cause?
Detects dead organisms too - if someone had previous infection
Why do legonella antigens detected in a urine test suggest definite infection?
Legionella not naturally found in humans, if detected=infection
Why can investigations for pneumonia be unreliable? (2)
- Sputum : some patients have a little pnuemonae
- Urine: children have some colonisation of pnuemonae bacteria : false positive
What type of patients is mycoplasma pneumoniae associated with?
Children and adolescents
