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Therapeutics V > Lower Respiratory Tract Infections - Community Acquired Pneumonia > Flashcards

Lower Respiratory Tract Infections - Community Acquired Pneumonia Flashcards

(75 cards)

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1
Q

Definition of community-acquired pneumonia

A

Pneumonia that developed outside of the hospital or within the first 48 hours of hospital admission

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2
Q

Three common ways to acquire community acquired pneumonia

A

-Aspiration
-Aerosolization
-Bloodborne

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3
Q

What is the most common pathogenic organism for CAP?

A

Virus

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4
Q

What microorganisms are primarily transferred through aerosolization to cause CAP?

A

-Viruses
-Mycobacterium tuberculosis
-Endemic fungi

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5
Q

What is the most common pathway to cause CAP?

A

Aspiration

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6
Q

Common bacterial pathogens that cause CAP

A

-Streptococcus pneumoniae
-Haemophilus influenzae
-Mycoplasma pneumoniae
-Legionella pneumophila
-Chlamydia pneumoniae
-Staphylococcus aureus

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7
Q

Which patient populations have an increased prevalence in streptococcus pneumoniae?

A

-Asplenia
-DM
-Immunocompromised
-HIV
-Chronic cardiopulmonary/renal disease

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8
Q

Risk factors for strep pneumoniae drug resistance

A

-Age less than 6 or over 65
-Prior antibiotic therapy
-Co-morbid conditions
-Day care
-Recent hospitalization
-Close quarters

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9
Q

Prevalence of penicillin resistance in strep pneumoniae across the US

A

3%

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10
Q

Prevalence of macrolide resistance in strep pneumoniae across the US

A

45-50%

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11
Q

What gram-stain is mycoplasma pneumoniae?

A

Atypical bacteria so it will not be identified on gram stain

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12
Q

How is mycoplasma pneumoniae spread?

A

Person-to-person contact so increased risk in close contact populations

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13
Q

How do mycoplasma pneumoniae symptoms typically present?

A

2-3 week intubation period followed by a slow onset of symptoms

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14
Q

What are symptoms commonly present with mycoplasma pneumoniae infections?

A

-Persistent, non-productive cough
-Fever
-Headache
-Sore throat
-Rhinorrhea
-N/V
-Arthralgia

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15
Q

What does imaging look like in patients with mycoplasma pneumoniae?

A

More pronounced with patchy, interstitial infiltrates

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16
Q

What gram-stain is legionella pneumophila?

A

It is an atypical pathogen so it does not appear on a gram stain

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17
Q

Where is legionella pneumophila typically found?

A

Found in water and soil

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18
Q

How is legionella pneumophila spread?

A

Spread by aerosolization

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19
Q

Which patient populations are at an increased risk of legionella pneumophila?

A

-Older males
-Chronic bronchitis
-Smokers
-Immunocompromised

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20
Q

What is the prevalence of staph aureus in CAP?

A

1-2%

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21
Q

Risk factors for MRSA?

A

-2-14 days post-influenza
-Previous MRSA infection/isolation
-Previous hospitalization
-Previous use of IV antibiotics

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22
Q

What tests are important to get in staph aureus infections?

A

MRSA nasal PCR

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23
Q

Which pathogens are common in alcoholism?

A

-S. pneumoniae
-Anaerobes
-K. pneumoniae

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24
Q

Which pathogens are common in COPD/smoker?

A

-S. pneumoniae
-H. influenzae
-Moraxella cattarhalis
-Legionella spp.

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25
Which pathogens are common in post influenza pneumonia?
-S. pneumoniae -S. aureus -H. influenzae
26
Which pathogens are common in structural lung disease (cystic fibrosis, bronchiectasis, etc.)?
-P. aeruginosa -S. aureus
27
Which pathogens are common in recent antibiotic exposure?
-S. aureus -P. aeruginosa
28
Clinical presentation of CAP
-Sudden onset of fever -Chills -Pleuritic chest pain -Dyspnea -Productive cough -Gradual onset with lower severity for mycoplasma and chlamydia pneumoniae
29
Clinical presentation of CAP in elderly patients
-Classic symptoms may be absent (afebrile, mild leukocytosis) -More likely to have decrease in functional status, weakness, and mental status changes
30
Important vitals for CAP
-Febrile -Tachycardia -Hypotensive -Tachypnea
31
What does a chest x-ray look like in CAP?
-Dense lobar consolidation or infiltrates = suspicion for bacterial origin -Patchy, diffuse, interstitial infiltrates = atypical or viral pathogens
32
What are common sputum characteristics to look for in CAP?
-Color -Amount -Consistency -Odor observed
33
Which gram stains should you only evaluate in CAP?
- > 25 PMNs - < 10 epithelial cells
34
What gram stain would be indicative of S. pneumoniae?
Gram positive diplococci
35
What gram stain would be indicative of H. influenzae?
Gram negative coccobacilli
36
Should you get a respiratory culture in CAP?
Controversial - negative in 40-50% of patients with CAP and difficult to obtain clean sample
37
Important to note about blood cultures
Always get 2 sets
38
Important markers to look at in CAP
-WBC with differential -SCr, BUN, electrolytes, LFTs -Pulse oximetry -Urinary antigen test (S. pneumoniae, legionella pneumophila) -Nasopharyngeal PCR swabs to test for MRSA or viral pathogens
39
When do you take cultures?
In severe CAP
40
What major criteria must be met in order to diagnose someone as severe CAP?
(Need 1) -Septic shock requiring vasopressors -Respiratory failure requiring mechanical ventilation
41
What minor criteria must be met in order to diagnose someone as severe CAP?
(Need at least 3) -Respiratory rate 30 or more -PaO2/FlO2 250 or less -Multilobar infiltrates -Confusion/disorientation -Uremia (BUN 20 or more) -Leukopenia (WBC less than 4000) Thrombocytopenia (Plt < 100,000) -Hypothermia (temp less than 36C) -Hypotension requiring aggressive fluids
42
What are some tools used during treatment of CAP?
-Procalcitonin -Pneumonia severity index (PSI) -CURB-65
43
What is procalcitonin used for when treating CAP?
-Should not be used to determine need for antibiotics for CAP -Useful in guiding duration of treatment if obtained throughout hospitalization
44
What is CURB-65?
-Confusion -Uremia (BUN over 19) -Respiratory rate 30 or more -Hypotension (SBP under 90 and DBP 60 or less) -Age 65 or more
45
What are the supportive treatments for patients with CAP?
-Humidified oxygen -Bronchodilators -Fluids -Chest physiotherapy
46
CAP outpatient empiric therapy for patients WITHOUT comorbidities or risk factors for antibiotic resistance
-Amoxicillin 1 gm PO Q8H -Doxycycline 100 mg PO BID -If macrolide resistance is less than 25%, azithromycin 500 mg PO on day 1, followed by 250 mg PO on days 2-5
47
CAP outpatient empiric therapy for patients WITH comorbidities or risk factors for antibiotic resistance
-Monotherapy: Respiratory FQs (levo, moxi) -Combo therapy: Beta-lactam (Augmentin, Cefpodoxime, cefuroxime) + macrolide or doxycycline
48
Non-severe CAP inpatient empiric therapy for patients WITHOUT MRSA/pseudomonas risk factors
-Monotherapy: Respiratory FQs (levo, moxi) -Combo therapy: Beta-lactam (ampicillin/sulbactam, ceftriaxone) + macrolide
49
Severe CAP inpatient empiric therapy for patients WITHOUT MRSA/pseudomonas risk factors
-Combo therapy: Respiratory FQ + beta-lactam (ampicillin/sulbactam, ceftriaxone) -Combo therapy: Beta-lactam (ampicillin/sulbactam, ceftriaxone) + macrolide
50
When would doxycycline be used inpatient for CAP?
IV/PO may be used if FQ or macrolide contraindicated
51
What are some risk factors for MRSA in CAP patients?
-2-14 days post-influenza -Previous MRSA respiratory infection/isolation -Previous hospitalization and use of IV antibiotics within last 90 days
52
What treatment would be used if a patient with CAP has a risk factor for MRSA?
-Vancomycin -Linezolid
53
What are some risk factors for pseudomonas in CAP patients?
-Previous pseudomonas respiratory infection -Previous hospitalization and use of IV antibiotics within last 90 days
54
What treatment would be used if a patient with CAP has a risk factor for pseudomonas?
-Piperacillin/tazobactam -Cefepime -Meropenem
55
What is the preferred therapy for a patient who has CAP and has penicillin susceptible strep pneumoniae?
-Penicillin G -Amoxicillin
56
What is the alternative therapy for a patient who has CAP and has penicillin susceptible strep pneumoniae?
-Ceftriaxone -Respiratory FQ -Doxycycline
57
What is the preferred therapy for a patient who has CAP and has penicillin resistant strep pneumoniae?
-Ceftriaxone -Respiratory FQ
58
What is the alternative therapy for a patient who has CAP and has penicillin resistant strep pneumoniae?
-Vanco -Linezolid
59
What is the preferred therapy for a patient who has CAP and has haemophilus influenzae?
-Second and third generation cephalosporin -Unasyn -Augmentin
60
What is the alternative therapy for a patient who has CAP and has haemophilus influenzae?
-FQ -Doxycycline -Macrolide
61
What is the preferred therapy for a patient who has CAP and has mycoplasma pneumoniae and/or chlamydia pneumoniae?
-Macrolide -Doxycycline
62
What is the alternative therapy for a patient who has CAP and has mycoplasma pneumoniae and/or chlamydia pneumoniae?
FQ
63
What is the preferred therapy for a patient who has CAP and has legionella pneumophila?
-FQ -Azithromycin
64
What is the alternative therapy for a patient who has CAP and has legionella pneumophila?
Doxycycline
65
What is the preferred therapy for a patient who has CAP and has MSSA?
-Cefazolin -Nafcillin
66
What is the alternative therapy for a patient who has CAP and has MSSA?
-Vanco -Clindamycin
67
What is the preferred therapy for a patient who has CAP and has MRSA?
-Vanco -Linezolid
68
What is the alternative therapy for a patient who has CAP and has MRSA?
-Ceftaroline -Bactrim
69
What is the preferred therapy for a patient who has CAP and has anaerobes?
-Beta-lactam/beta-lactamase inhibitor -Add metronidazole if using cephalosporin
70
What is the alternative therapy for a patient who has CAP and has anaerobes?
-Carbapenem -Clindamycin
71
What is the preferred therapy for a patient who has CAP and has enterobacterales?
-Third/fourth gen cephalosporin -Carbapenem
72
What is the alternative therapy for a patient who has CAP and has enterobacterales?
-Beta-lactam/beta-lactamase inhibitor -FQ
73
When would corticosteroids be used for CAP?
Only recommended if the patient has CAP AND septic shock
74
How long should the duration of CAP therapy be?
-Ensure clinical stability prior to discontinuing antibiotics -Continue antibiotics until clinical stability for a minimum of 5 total days
75
What should vitals be for someone to be clinically stable?
-Temperature 38C or lower -HR 100 or less -RR 24 or less -SBP 90 or more -O2 sat. 90% or more on room air -Baseline mental status

Therapeutics V (52 decks)

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