Bacterial Pneumonia Flashcards Preview

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Flashcards in Bacterial Pneumonia Deck (29):
1

tyes of pneumonia

community-acquired pneumonia

nosocomial pneumonia - hospital-acquired, ventilator-associated, and healthcare-associated

2

typical symptoms of pneumonia

dry or productive cough

dyspnea

fever

3

diagnostic findings for pneumonia

dullness to percussion

bronchial breath sounds

E to A changes (egophony)

CXR shows pattern distinf for pneumonia

gram stains, blood cultures, or bronchoscopic smpling are other tests

4

hospital-acquired pneumonia (HAP)

> 48 hours after admission, not incubating at the time of admission

5

ventilator-associated pneumonia (VAP)

> 48-72 hours after endotracheal intubation

6

healthcare-associated pneumonia (HCAP)

hospitalized within 90 days

resident of a nursing home or long-term care facility

intravenous antibiotic therapy, chemotherapy, or wound care within 30 days

attended a hospital or hemodialysis clinic

7

pathogenesis of pneumonia

aspiration of upper flora

inhalation of aerosolized organisms

hematogenous spread

8

factors that increase risk of pneumonia

impaired level of consciousness

impaired cough reflex

alveolar macrophage dysfunction

9

How does pneumonia develop in an intubated patient?

 Secretions will accumulate around the inflated cuff

Leaks around the cuff will allow secretions to pass down into the lungs

  Increased risk for pneumonia because there is no way for the lungs to clear

10

inhaled pathogens

influenza

coxiella burnetii (Q fever)

anthrax

tuberculosis

aspergillosis

histoplasmosis

11

hematogenous pathogens

tricuspid valve: S. aureus endocarditis

retropharyngeal abscess/jugular venous thrombophlebitis: Fusobacterium spp. (Lemierre's syndrome)

12

patterns of pneumonia

lobar pnuemonia

bronchopneumonia

interstitial pneumonia

lung abscess

13

most common pathogens that cause CAP

streptococcus pneumoniae

Haemophilus influenzae

Mycoplasma pneumoniae

Chlamydophila pneumoniae

Legionella pneumophila

oral anaerobes, influenza virus, respiratory syncytial virus

14

How does particle size affect deposition of inhaled particles?

large particles > 10 microns impact nose and upper airways

very small particles < 1-3 microns fail to settle out by gravity and remain suspended in the air

droplet nuclei particles 3-5 microns are deposited in the small airways and alveoli and may result in infection

15

What are common pneumonias are caused by aerosols

influenza

tuberculosis

llegionellosis

histoplasmosis

Q fever

anthrax

16

typical pneumonia

commonly caused by S. pneumoniae and H. influenzae

sudden onset of fever

cough productive of purulent sputum

pleuritic chest pain

signs of pulmonary consolidation

17

atypical pneumonia

commonly caused by M. pneumoniae and C. pneumoniae

gradual onset

low grade fever

dry cough

minimal evidence of pulmonary involvement on physical exam

18

clinical diagnosis of nosocomial pneumonia

new or progressive pulmonary infiltrates

purulent tracheobronchial secretions

fever

leukocytosis

19

differential diagnosis of nosocomial pneumonia

fluid overload

atelectasis

pulmonary hemorrhage

pulmonary embolism

malignancy

20

scoring systems to determine if a person with CAP can receive outpatient treatment

CURB-65 (confusion, uremia, respiratory rate, low blood pressure, age >/= 65 years)

Pneumonia Severity Index (PSI)

21

management of CAP

empiric antibiotic therapy - respiratory fluoroquinolone (moxifloxacin or levofloxacin)

beta-lactam plus a macrolide (ceftriaxone plus azithromycin)

22

management for nosocomial pneumonia

obtain appropriate samples

begin a combination of antibiotics to treat the most common pathogens based on local antibiograms, prior antibiotic exposure, early vs. late onset

de-escalate antibiotics based on results of clinical microbiology evaluation

23

antibiotic therapy for nocosomial pneumonia

early-onset and no risk factors for MDR pathogens - limited spectrum antibiotic therapy

late-onset (>/= 5 days) or risk factors for MDR pathogens - broad spectrum antibiotic therapy for MDR pathogens

24

risk factors for MDR pathogens

antimicrobial therapy within 90 days

current hospitalization of five days or more

hospitalization for more than two days within 90 days

high frequency of antibiotic resistance in the community or in the specific hostial unit

resitence in nursing home or extended care facility

home infusion therapy

chronic dialysis

home wound care

family member with multidrug-resistant pathogen or immunosuppressive disease and/or therapy

25

antibiotics for MDR pathogens

broad spectrum

ex. meropenem or linezolid plus azithromycin

26

prevention of community-acquired pneumonia

influenza vaccine

pneumococcal polysaccharide vaccine

pneumococcal conjugate polysaccharide vaccine

27

nosocomial pneumonia prevention

effective infection control

avoid intubation whenever possible

semi-recumbent positioning

continuous suctioning of subglottic secretions

28

treatment regimen for HAP

antibiotic therapy initially directed at anticipated pathogens and later tailored to organisms identified in cultures of respiratory secretions

blood or pleural fluid and supportive care

29

initial antimicrobial therapy for VAP

selected according to the presence or absence of risk factors for infection associated with health care

initial antimicrobial regimens for someone with risk factors should appropriately treat potentially resistant pathogens including MRSA and Pseudomonas aeruginosa