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PHRM 865 > LRTI > Flashcards

LRTI Flashcards

(66 cards)

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1
Q

host interventions that can increase likelihood of infection

A

smoking
alcohol
altered level of consciousness
endotracheal tube

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2
Q

host disease states increasing risk of infection

A

immunosupression
diabetes
asplenia
elderly

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3
Q

pathogen mediated ways infections can happen

A

surface adhesions
pili
exotoxins
enzymes

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4
Q

define community acquired pneumonia

A

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

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5
Q

what is the most common cause of infection related hospitalization and mortality in the US

A

CAP

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6
Q

what is the most common pathway for bacteria pneumonia

A

aspiration

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7
Q

when does aspiration happen

A

during sleep
disorders that impair consciousness and depress gag reflex

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8
Q

what are the three ways that infection can happen

A

aspiration
aerosolization
bloodborne

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9
Q

what microorganism class is the most common pathogenic organism for CAP

A

virus

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10
Q

common bacterial pathogens of CAP

A

strep pneumoniae
haemophilus influenza
mycoplasma pneumoniae
legionella pneumophila
chlaymydia pneumoniae
staph aureus

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11
Q

which bacterial organism is most common in CAP?

A

strep pneumo

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12
Q

risk factors for drug resistance to strep

A

< 6 years
> 65 years
prior antibiotic therapy
co-morbid conditions
close quarters

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13
Q

how is mycoplasma pneumoniae spread

A

person to person contact

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14
Q

mycoplasma pneumoniae symptoms

A

2-3 week incubation period, slow onset of symptoms
cough, fever, headache, sore throat, N/V

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15
Q

what may we see with imaging in someone with mycoplasma

A

patchy interstitial infiltrates

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16
Q

what are the atypical pathogens for CAP?

A

legionella
mycoplasma
chlamydia

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17
Q

how is legionella spread

A

aerosolization

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18
Q

who is at increased risk of legionella?

A

older males, chronic bronchitis, smokers, immunocompromsied

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19
Q

legionella characteristics and symptoms

A

multisystem involvement - high fevers, bradycardia, multi-lobar involvement, mental status change, LFT increase

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20
Q

staph aureus prevalence in CAP

A

low prevalence

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21
Q

risk factors for MRSA

A

2-14 days post flu
previous MRSA infection
previous hospitalization
previous use of IV antibiotics

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22
Q

what should we get if starting someone on empiric MRSA therapy?

A

MRSA nasal PCR - helps us rule OUT MRSA, doesn’t diagnose but tells us we don’t have

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23
Q

alcoholism organism risk

A

strep pneumo
anaerobes
klebsiella pneumonia

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24
Q

COPD/smoker risk pathogens

A

h flu, strep pneumo, moraxella, legionella

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25
post influenza pneumonia risk pathogens
strep pneumo staph aureus h flu
26
structural lung disease risk pathogens
pseudomonas aeruginosa staph aureus
27
recent antibiotic exposure risk pathogens
staph pseudomonas
28
which pathogens have a slower onset of symptoms in CAP
mycoplasma chlamydia
29
how might CAP symptoms be different in elderly?
no fever decrease in functional status, weakness, mental status changes
30
vitals associated with CAP
fever >38 HR > 90 SBP <90 RR >20
31
CAP presentation on Xray bacterial
dense lobar infiltrates consolidation
32
CAP presentation on XRAY viral or atypical
patchy, diffuse interstitial infiltrates
33
what quality of samples can we evaluate
>25 PMNs <10 epithelial cells
34
testing we should get in CAP
could get resp culture - more used in HAP blood culture WBC SCr,BUN, LFTs O2 sat Urinary antigen tests nasopahyngeal PCR swab
35
what do we use urinary antigen tests for
strep penumoniae legionella pneumophila (helpful in getting a positive but we don't change therapy)
36
what do we use nasopharyngeal PCR swabs for
MRSA and viral tests
37
when do we get a respiratory culture and a blood culture?
HAP/VAP
38
severe CAP major criteria (1)
septic shock mechanical ventillation
39
severe CAP minor criteria (3)
RR >30 multilobar infiltrates confusion/disorientation BUN >20 WBC < 4,000 Platelet < 100,000 temp <36 hypotension requiring fluids
40
procalcitonin used for what
guides duration of treatment not useful for starting therapy
41
supportive measures used in CAP
humidified oxygen bronchodilators fluids chest physiotherapy
42
empiric CAP outpatient therapy - no comorbidities
amoxicillin doxycycline - azithromycin if <25% resist
43
empiric CAP outpatient therapy - comorbidities
beta lactam + macrolide/doxy - amox/clav - cefpodoxime - cefuroxime
44
empiric CAP inpatient therapy - non-severe (no pseudomonas or MRSA risk)
beta lactam + macrolide - ampicillin/sulbactam - ceftriaxone - doxy if contraindicated levofloxacin moxifloxacin
45
empiric CAP inpatient therapy severe (no pseudomonas or MRSA risk)
beta lactam + macrolide (FQ np) - ampicillin/sulbactan - ceftriaxone - doxy if contraindicated
46
empiric CAP MRSA risk factors
2-14 days post influenza previous MRSA infection previous hospitalization w use of IV antibiotics within last 90 days
47
empiric CAP MRSA coverage to add
linezolid vancomycin
48
empiric CAP pseudomonas risk factors
previous pseudomonas inf previous hosp and IV antibiotic use within last 90 days
49
empiric CAP pseudomonas coverage agents
piperacillin/tazobactam cefepime meropenem
50
are corticosteroids reccommended in CAP?
no, only if septic shock
51
how long should we continue CAP therapy?
5 days minimum
52
clinical stability factors for discontinuation of antibiotics
temp <38 for 24 hrs HR <100 RR <24 SBP >90 O2 sat >90 baseline mental status
53
what is HAP and VAP
occurring > 48 hours post admission and for VAP after endotracheal intubation
54
pathogenesis of HAP
miro aspirations of secretions, usually 3-5 days after hospitalization and coverts to gram negative organisms aspiration GI contents blood source direct inoculation via intubation mechanical vent
55
presentation of HAP/VAP
new lung infiltrate or new onset of fever, purulent sputum, leukocytosis
56
common pathogens for HAP/VAP
pseudomonas enteric gram negative bacilli acinetobacter staph aureus (MRSA
57
microbiology testing done in HAP/VAP
respiratory culture blood culture
58
invasive respiratory culture threshold for sample
specimen brush <10^3 CFU BAL: < 10^4
59
risk factors for MDR VAP
prior IV antibiotic use within 90 days septic shock at time of dx ARDS prior to dx acute renal replacement therapy > 5 days hospitalization
60
when to cover MRSA HAP
risk factors ICUs where > 10% MRSA isolates
61
MRSA coverage treatment for HAP
linezolid vancomycin
62
pseudomonas coverage treatment for HAP
piperacillin/tazobactam meropenem imipenem levofloxacin cefepime
63
empiric HAP - not at high risk for mortality (not on vent or septic shock)
piperacillin/tazobactam meropenem imipenem levofloxacin cefepime one of those PLUS MRSA (if risk) linezolid vanc
64
empiric HAP - high risk for mortality (septic shock or vent)
piperacillin/tazobactam meropenem imipenem levofloxacin cefepime tobramycin/amikacin 2 of those in diff classes plus vanc or linezolid
65
duration of therapy for HAP and VAP
7 days minimum if clinically stable
66
VAP - does longer therapy decrease mortality?
no, 7 days is good

PHRM 865 (33 decks)

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