Flashcards in ID - Pneumonia Deck (27):
Most common pathogen for community community acquired pneumonia? For nosocomial pneumonia?
Gram-negative rods (E. coli, Pseudomonas) and staph aureus
Definition of Community acquired pneumonia versus Nosocomial pneumonia?
Acquired before or within 48-72 hours of hospitalization versus later
Infection from community acquired pneumonia result from what mechanism?
Aspiration of oropharyngeal secretions
Sputum in bacterial PNA?
PE sIgn bacteremic pneumonia?
Main Types of lower tract infection?
Next test to order?
Pneumonia and acute bronchitis.
Test to order invitations with suspected pneumonia?
1. Chest x-ray
2. Labs – CBC, BUN, creatinine, glucose, electrolytes
3. O2 sat
4. 2 pretreatment blood cultures
5. Gram stain and culture of sputum
Most common causes of atypical pneumonia if bacterial?
2. Chlamydia pneumonia
3. Chlamydia psittaci
4. Coxiella (Q fever)
1. Alcoholic pneumonia?
2. Immigrants with pneumonia?
3. Nursing home resident with pneumonia?
4. HIV-positive patient with pneumonia?
5. COPD pt?
7. Young, healthy pts?
4. PCP and TB
5. H flu
6. Strep Peumo
Test if suspect Legionella?
If suspect and need to confirm PCP?
Urinary antigen assay (antigen persists in urine for weeks)
Considered admitting to hospital if?
CURB65 of 2+
BP under 90
#pH under 7.35
#Temp > 104
#Cancer, COPD, CHF, Renal failure, Liver disease
If pneumonia becomes empyema, need to?
Place chest tube for drainage
Areas of the lungs that may developed abscesses from aspirated contents?
Posterior segments of upper lobes and superior segments of lower lobes
Pts with high risk of pneumonia: history?
History of cancer
Every patient with pneumonia will have a visible pulmonary infiltrate on chest x-ray except?
#very early pneumonia
Diffuse interstitial infiltrates are common in pneumonia caused by?
PCP PNA can be ruled out if?
PCP much less likely if?
#Pleural effusion is present
Appearance of cavitation suggests?
TB, staph aureus, gram-negative organisms (Klebsiella)
With sputum results, how to determine if it is uncontaminated?
>25 PMNs and <10 epithelial cells
Outpatient therapy of community acquired pneumonia?
When to add fuoroquinolone?
Hospitalized patients with community acquired pneumonia are treated with?
Macrolides (azithromycin) or Doxycyclne
ABx in last 3 months or comorbidities
Fluoroquinolone OR Ceftriaxone+Azithromycin
Treatment for immunocompetent patient with hospital-acquired or ventilator-associated pneumonia?
Antipseudomonal beta-lactam (Zosyn/cefepime) plus aminoglycoside (may also add clindamycin)
1. Pt with hemoptusis and cureant jelly suputum?
2. Foul-smelling sputum?
3. Mryingitis (infx and vesicles on tympanic membrane)
4. Legionella presents with hypoNa, GI sx and?
Who should get pneumovax?
#Heart, lung, liver, kidney disorders
#CSF leak, cochlear implants
Abx can can cause seizures and renal failure?
Do not order this test if suspect aspiration PNA?
Sputum culture (everyone's sputum has anaerobes from mouth)
Suspect lung abscess - imaging? tx?
CXR/CT for cavitation
Clindamycin or Penicillin