Lower RT Infections Part 1 Flashcards Preview

Week 6: Pneumonia and Cough > Lower RT Infections Part 1 > Flashcards

Flashcards in Lower RT Infections Part 1 Deck (28):
1

4 pathogens of CAP found in the mouth and URT

Strep pneumoniae
Haemophilus influenzae
Moraxella
Mycoplasma

2

2 ways pneumonia happens

Lower RT is usually sterile
Aspiration
Inhalation by droplet/aerosol transmission

3

3 defence mechanisms of the lungs

Mucus and mucociliary clearance
Cough
Humoral and cellular immunity

4

4 droplet bacteria vs 3 droplet nuclei bacteria

Droplet: Influenza, Group A strep, Mycoplasma, Neisseria meningitidis
Nuclei: Measles, TB, Varicella

5

Top 3 typical bacteria that cause CAP (and what is their morphology)

Strep pneumoniae (gram + cocci in pairs)
H. influenzae (gram - coccobacilli)
Moraxella catarrhalis (gram - diplococci)

6

Top 2 atypical causes of CAP

Mycoplasma pneumoniae
Chlamydophila pneumoniae (gram - obligate intracellular bacteria)

7

Legionella pneumoniae

Rare cause of pneumonia
Can be severe though!
Causes outbreaks
Doesn't gram stain well

8

Most common cause of pneumonia in children 1mo to 5yrs

Viral!!

9

Hospital acquired pneumonia
1. what is it
2. what pathogens are most likely

Pneumonia occurring >48 hours after hospital admission
Strep pneumo and Haemophilus are still most likely
Also S aureus, Pseudomonas, and Enterobacteraciae

10

Ventilator associated pneumonia

Pneumonia occurring >48 hours after intubation
Even more likely to be resistant to nosocomial organisms

11

What two categories are usually found in
1. acute
2. chronic
pneumonias

1. Bacterial or viral
2. Mycobacterial, fungal

12

4 things to look for on clinical presentation for pneumonia

Cough (+/- purulent sputum)
Fever
Shortness of breath (decline in oxygenation)
Abnormal lung exam (rales, rhonchi, dullness to percussion)

13

3 things to look for on Lab data for pneumonia

Elevated WBC count
Abnormal chest x-ray
Resp sample: sputum, bronchoalveolar lavage, tracheal aspiration

14

2 problems with sputum

Obtaining a good lower RT sample is difficult
Good samples can show more than one organism or no organism (doesnt stain)

15

2 things you should have in a good sputum sample

Less than 10 squamous epithelial cells
Many polymorphonuclear lymphocytes

16

Sputum gram stain and culture should only be performed in which 4 conditions

When a good quality sample can be obtained
For hospitalized patients with severe underlying lung disease
For patients who have failed antibiotic therapy, or in whom antibiotic resistance is suspected
For patients with suspected TB

17

When do you do blood cultures?

Only for hospitalized patients with severe CAP
Because they have low sensitivity after antibiotics are started

18

3 problems with serology

Delay in diagnosis
Variable sensitivity
Cross-reactivity

19

2 pathogens that have urine antigen testing

Legionella
Strep pneumo (not routine)

20

Pros and cons to urine antigen testing

Pros: more sensitive and specific than sputum gram stain and culture, urine more readily available, immediate results, still works after antibiotics started
Cons: sensitivity less in patients without bacteremia, can't do antibiotic susceptibility testing

21

3 times that identifying the specific organism actually becomes important

Resistant bacteria
Bacteria not covered by standard empiric therapy (staph, pseudomonas)
Non-bacterial pathogen (influenza season, immune suppressed)

22

Antibiotics that work against common bacteria
1. which bacteria
2. 6 drugs

1. Strep pneumo, H influenzae (+ or - beta lactamase), Moraxella
2. Amox-clav, Cefuroxime, Ceftriaxone, Doxy, Levofloxavin, and Moxifloxacin (but the fluoros are second line)

23

5 antibiotics that work against bacteria without a cell wall or intra-cellular organisms

Clarithromycin
Azithromycin
Doxycycline
Levofloxacin
Moxifloxacin
NO BETA LACTAMS

24

CAP
1. Mild/moderate drugs
2. Severe drugs

1. Doxy, or Amox-clav and macro/doxy
2. Ceftriaxone and doxy or ceftriaxone and azithromycin

25

How long do you treat
1. CAP
2. HAP or VAP

1. 5 days
2. 7 days

26

6 main bacteria that cause HAP or VAP

Strep pneumo
H influenzae
Staph aureus (including MRSA)
Pseudomonas
Enteric gram - bacteria
Anaerobes

27

Drugs for VAP or HAP

Pip-taxo
Meropenem/imipenem
Cefepime/ceftazidime
Ciprofloxacin/levofloxain
One of those plus or minus Vancomycin (MRSA) or Linezolid

28

CRB-65 Score

Prognosis score
Confusion, resp rate (> 30), BP ( < 90/60), age (> 64)
All those are 1 point
If you get greater than 1, hospitalize