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PR3124 CA3 > CAP > Flashcards

CAP Flashcards

1
Q

what is the pathogenensis of pneumonia? (3 mechs)

A
  • aspiration of oropharyngeal secretions
  • inhalation of aerosols (containing bac)
  • hematogenous spreading (bac inside blood, carry to lungs–> bac replicate in lungs–> pneumonia, bacteremia from extra pulmn source)
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2
Q

s/sx of pneumonia

A
  • cough, chest pain
  • SOB, hypoxia
  • fever >38C, chills, fatigue, anorexia
  • tachypnea, tachcardia, hypotension
  • leukocytosis
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3
Q

what physical examination is done to assess pneumonia

A
  • diminished breath sounds over affected area

- inspiratory crackles during lung expansion

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4
Q

pneumonia lab findings

A

eg. C reactive protein, procalcitonin
- non specific
- limited discriminatory potential
- not rec for routine use

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5
Q

what resp cultures are taken ? (2)

A
  1. sputum culture
    - low yield (may not be able to identify bac that is causing pneumonia), freq contamination by oropharyngeal secretion
    - quality sample: >10 neutrophils (indicate infection) AND <25 epithelial cells (less contam by motuh flora) per low power field
  2. lower resp tract sample
    - less contamination
    - invasive sampling
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6
Q

Why are blood cultures taken for pneumonia

A

to eliminate bacteremia

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7
Q

what org does urine antigen test identify?

A
  • strep pneumoniae

- legionella pneumophilia

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8
Q

limitations of urien antigen test?

A
  • indicate exposure to respective pathogen (pt exposed to pathogen but doesnt mean it caused the pneumonia)
  • remain positive for days-weeks despite ab tx

not routinely used

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9
Q

define hospital acquired ppneumonia HAP

A

onset >=48 h after hospital admin

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10
Q

define ventilator assc pneumonia

A

onset >48h after mechinical ventilation

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11
Q

define community acquired pneumonia CAP

A

onset in community or <48h after hospital admin

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12
Q

what are the 3 classificatiosn of pneumonia

A

hospital acquired
ventilator assc
community acquried

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13
Q

risk factors for CAP

A

age>65
previosu hospitalisation for CAP
smoking
COPD, DM, HF, cancer, immunosup

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14
Q

how to prevent CAP

A

smoking cessation, immunisation (influenza, pneumococcal)

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15
Q

how does severity of CAP determine tx (4)

A
  • location of tx
  • org that need to be covered
  • empiric ab selection
  • ROA of ab
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16
Q

criterion for CAP risk stratification (CURB-65)

A
  • confusion
  • urea > 7mmol/L
  • RR >39 breaths/min
  • Blood pressure (sbp<90, dbp<60)
  • age >65

if the total score is 0 or 1: outpat
score 2: inpatient
score >=3: inpt, consider ICU

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17
Q

what are teh moajor criterias for severe CAP

A
  • mech ventilation

- septic shock vasoactive medications

18
Q

minor criterias for severe cap?

A
  • RR>30
  • hypoxia, paO2>250
  • multilobar infiltrates
  • confusion
  • uremia (urea>7mmol/L)
  • leukopenia (WBC<4x10^9
  • hypothermia (core tmpe<36)
  • hypotension req aggressive fluid resuscitation
19
Q

what is criterias do we need to diagnose for severe CAP?

A

> =1 major
or
=3 minor

20
Q

what are the potential org to cover for OUTpt

A
  • strep pneumo
  • haemophilus influenzae
  • atypical org
21
Q

what is the empiric therapy for generally healthy outpt

A
  • beta lactam (amoxicillin)
    or
    resp FQ eg. levo or moxifloxacin`
22
Q

what is the empiric therapy for pt pop with chronic heart, lung, liver renal disease, DM.. outpt

A

need to cover atypical as well

1. beta lactam (amox/clav) pr cefuroxime
PLUS macrolide (clarithromycin or azithromycin) or resp FQ (levo/moxi)
23
Q

what is the standard regimen for inpatient non severe

A
  1. beta lactam (amox/clav or ceftriazone) PLUS macroldie (clarithromycin or azithromycin)
    or resp FQ (levo/moxi)
24
Q

ROA of inpt non severe?

A

beta lac and FQ admin IV- step down to PO when pt imrpoves

macrolide and doxycycline PO

25
what is the regimen for inpatient severe?
``` 1. beta lactam (pen G or amox/clav PLUS ceftrazidime) plus 2. macrolide or doxycycline OR resp FQ (levo/moxi) PLUS ceftazidime (to cover burkholderia) ```
26
what organisms to cover for inpt severe?
- strep pneumo - H flu - atypical org - s aureus - other gram neg bacilli
27
when to cover anaerobic? what indications? (2)
- lung abscesss | - empyema (abscess in lung pleural space)
28
what ab to add when standard regimen has no anaerobic cov?
clindamycin IV/PO | metronidazole IV/PO
29
what indications to cover for MRSA? (2)
- prior respiratory isolation of MRSA in last 1 year - severe CAP only, hospitalisation and received IB ab within last 90 days and locally validated risk factors (look at antibiogram to check which MRSA is common)
30
what ab to add wto cover MRSA? (2)
vancomycin IV | linezolid IV/PO
31
what indicatiosn to cover for pseudomonas?
prior resp isolation of ps. aeruginosa in last 1 year
32
how to modify standard regimen to cover ps/
``` include pip/tazo IV, or ceftazidime IV or cefepime IV or meropenem IV or levofloxacin IV/PO ```
33
Why dont we use resp FQ as first line for CAP
- many adverse effects eg. tendonitis, tendon rupture, neuropathy, qtc prolongation, cns disturbances, hypoglycemia - dev of resistance with overuse - preserve activity for other gram neg infections-- its the only PO option to cover pseudomonas, dw to anyhow use - delay diagnosis of tb
34
why is adjunctive coritcosteroid therapy considered for soem pt?
- less inflammation in the lungs - variable drug and dosing regimens - may reduce length of stay and tiem to clinical stability - NOT ROUTINELY REC
35
how to monitor safety of therapy?
- adverse effects eg. diarrhea, rash | - renal func
36
hwo to monitor efficacy of therapy?
- clinical improvemnt expecte din 48-72h - less cough, chest pain, SOB, fever, wbc - elderly pt or those with multiple co-morbs may take longer - should not escalate ab therapy in the first 72h (unless culture directed or significant clinical deterioration) - rediographic improvement lags behind (4-6 weeks for reso)- repeat only if clnical deterioration eg. chest xray
37
when to stop empiric cov for MRSA or ps. aeruginosa?
- may be stopped in 48h if no mRSA or ps is foun din culture AND pt is improving
38
when can IV ab be stepped down to PO?
- hemodynamically stable - clinically improved - aferbile >24 h - able to ingest PO med - normally functioning GIT
39
what are the general benefits of IV to PO? (5) | -
- higher pt comfort and mobility - less risk of nosocomial axquired bloodtream infection - less phlebitis - decreased prep and admin time - lower cost - facilitates discharge
40
what is the tx duration ?
until clinical stability is achieved and for at elast 5 days - most achieve clinical stab in 48-72h exceptions - MRSA, ps: 7 days - burkholderia: 3-6months
41
what is considered clincal stable?
- afebrile, able to maintain oral intake, normal vital signs, o2 saturation and mental status

PR3124 CA3 (6 decks)

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