Pneumonia Flashcards
Differentiate the two types of pneumonia and their pathologies
Community acquired pneumonia
Hospital acquired pneumonia
They are both caused by either bacterial or viral pathogens e.g strep pnuemoniae, gram negative enteric bacilli, E.coli, staph aureus, legionella spp
Viruses . - haemophilus influenzae (A and B), mycoplasmic pneumoniae,
How is community acquired pneumonia diagnosed in primary setting ?
Acute illness <21 days
cough
At least 1 symptom of lower resp tract infection e.g fever, sputum production, breathlessness, wheeze (OR chest pain, COPD exacerbation),
AND use of CRB65
confusion, respiratory rate, blood pressure (low), age 65 or over.
1 point per item, score of 3-4 high risk
How to assess confusion in CRB65?
Asking the patient a series of questions eg age DOB Name of the hospital Identification of 2 persons e. gnurse and dr Recall address Year Time Date of a significant event Name of the monarch Count backwards from 20 to 1 (A score of 8 or less suggests mental confusion)
How is CAP diagnosed in hospital?
Chest X ray confirms the diagnosis
CURB65 –> confusion, urea 7mmol/l or more, resp rate 30/min or more, BP <90 systolic and <60 diastolic , 65 or over
Also - oxygen sats, C-reactive protein, microbiological tests e.g sputum and blood, full blood counts, LFTs
Describe CURB65
Confusion
Urea - 7 mmol/L or more
Respiratory rate 30 breaths per min or more
Blood pressure LOW <90 mmhg systolic or <60 mmhg diastolic
age 65 or over
What is the treatment distinctions for the severities of CAP?
Treating low severity - use of 1 AB for 5 days - usually amoxicillin 1st line
Moderate severity and high - use of dual AB therapy for 7 -10 days
How to treat moderate severity CAP
Amoxicillin and macrolide e.g erythromycin or clarithromycin for 7-10 days
How to treat high severity CAP in hospital
Broad spectrum beta lactamase stable Beta lactam AB - e.g Co-amoxiclav, cefotaxime or cefuroxime AND erythromycin or clarithromycin - 7-10days
How do we monitor for efficicacy in CAP / monitor for discharge?
Improvement shown within 48-72hours. ONLY discharge if: Temp is <37.5 degrees Heart rate is less than 100bpm Resp rate <24bpm Systolic BP is >90mmhg Oxygen sats are >90% Normal mental status Eat without assistance Do not discharge if patient didn't show <2 of these in the past 24hours.
How to optimise therapy in CAP?
When a patient has severe CAP it is common to use parenteral therapy - but we want to de-escalate this within a few days/reduction in severity ie as soon as appropriate for the patient - switching to oral therapy - also want to narrow the spectrum as soon as we identify the pathogen
Other treatments for CAP/symptomatic/non pharmacological?
Relieve pleuritic pain with paracetamol and nsaids
Relieve fever - usually para
Salbutamol
Fluids
Oxygen therapy but only if their PaO2 is <8 kPa or systolic is <100mmhg and resp rate >24 bpm
What is hospital acquired pneumonia?
Pneumonia that occurs 48 hours or more after hospital admission and is not incubating on admission, more commonly acquired on the ITU so common risk factors are:
stroke, chronic lung disease, recent surgery, mechanical infiltration, previous AB treatment
Treatment for HAP
EMPIRICAL treatment as soon as possible after diagnosis and within 4hours.
This is good as the mortality could be lower if the emiric treatment is effective.
However –> unnecessary use of extended spectrum ABs and inappropriate use of 1st line abs - could lead to resistance. Also empiric treatment usually needed to be changed in most cases anyway.
How to prevent HAP?
Hand hygeine, PPE, sterilisation and disinfection of equipment and instruments
Patient procedures
