Bacterial Pneumonia 2

Question 1

List the pathogens for HAP in details

Answer 1

Gram Positive staphylococci
* S. aureus
Gram Negative enterics
* K. pneumoniae
Gram Negative nonenterics
* P. aeruginosa
* H. influenzae
* M. catarrhalis

Question 2

what is HAP

Answer 2

Lower respiratory tract infection not present on admission
Occur >48 hours after admission

Question 3

Risk factors for HAP

Answer 3

• Hospitalized > 5 days
• Hospitalized > 2 days in past 3 months
• Immunocompromised with poor functional status
• Developed pneumonia after admission to ICU
• Mechanical ventilation

Question 4

The diagnosis of HAP is based on?

Answer 4

New infiltrate on CXR
* Fever
* Worsening respiratory status
* Thick secretions (neutrophil-containing)

Question 5

Lists the cultures for HAP

Answer 5

Collect PRIOR to initiating empiric therapy
Sputum or trachael aspirate

Question 6

Drug treatment for HAP
explain and list them

Answer 6

• Choice depends on local susceptibility patterns and previous
  antibiotic exposure (within 90 days)
• No risk factors for MDR infections
  Ceftriaxone, IV AND
  Amikacin, IV for 10 days
  Severe Penicillin Allergy
  Moxifloxacin, PO/IV
  AND Amikacin, IV

Question 7

Explain the diagnosis of VAP

Answer 7

Diagnosis
* > 48 hours post-endotracheal intubation
* No “gold standard”
* Suspect with worsening CXR and other findings consistent with HAP

Question 8

List the drug treatment for VAP

Answer 8

Piperacillin/tazobactam, IV, AND Amikacin, IV
OR Cefepime
Carbapenem with activity against Pseudomonas
Imipenem, IV
(Except CNS infections or known epileptics)
Meropenem, IV (CNS infections or known epileptics)

Question 9

What is meant bu aspiration pneumonia

Answer 9

Acute aspirations do not require antimicrobial therapy – even if
associated with CXR infiltrate

Question 10

Explain the treatment of Apiration pneumonia

Answer 10

Consider treatment with aspiration pneumonitis and persistent or
progressive signs/symptoms 48 hours after aspirating
* Amoxicillin/clavulanate
* Cephalosporin PLUS clindamycin or metronidazole

Question 11

List points under antimicrobial stewardship princilples

Answer 11

. Empiric treatment
* Obtain cultures
* Narrow treatment if warranted
* IV to PO switching
* Appropriate treatment duration

Question 12

Antimicrobial Stewardship principles
From IV to PO considerations

Answer 12

Haemodynamically Stable (HR < 100/min) (no
IV fluid need)
Respiratory Stable (RR < 25/min) (O2 sat
> 92% room air)
Free of fever – temperature < 37.8 C
Free of delirium
Able to take oral medication
* Able to swallow, no vomiting, no diarrhoea

Question 13

Explain the Pneumonia preventive strategies

Answer 13

Pneumococcal vaccines
* 23-valent polysaccharide (PPSV23)
* 13-valent pneumococcal conjugate (PCV13)
Pneumococcal polysaccharide vaccine (PPSV)23
* 19-64 underlying comorbid conditions, smoke, immunocompromised
* All persons 65 + years of age
Pneumococcal conjugate vaccine (PCV)13
* Single dose > 18 years
* High risk: sickle cell disease and HIV
* Trivalent Influenza Vaccine

Question 14

who should recieve influenza vaccine

Answer 14

Pregnant women
HIV-infected adults
Healthcare workers
High-risk for influenza
Old-age home and chronic care/rehabilitation
residents
Age > 65
Children 6-59 months
Persons < 18 years on long-term aspirin therapy
Adults and children family contacts of those at
influenza high-risk
Any person wishing to minimize influenza acquisition

Question 15

Causative agent for PJP

Answer 15

Causative agent: Pneumocystis jiroveci (formerly carinii)

Question 16

Risk factors for PJP

Answer 16

Risk factors: Advanced HIV

Question 17

Symptoms of PJP

Answer 17

Symptoms: SOB, dry cough

Question 18

Medicine treatment for PJP

Answer 18

Medicine treatment:
* Acute: Cotrimoxazole (80/400mg 4 tabs), 6 hourly for 3 weeks
* Secondary prophylaxis: Cotrimoxazole (80/400mg 2 tabs), oral daily until CD4
count is >200 cells/mm3