Pneumonia

Question 1

RF for Pneumonia (CAP)

Answer 1

> 65
Alcohol or tobacco Use disorder
Pulmonary comorbidities (COPD or asthma)
immunosuppression
Influenza

Question 2

Which urinary antigen assays are helpful in diagnosing CAP

Answer 2

Strep pneumo (recommended in all cases except very severe, as severe CAP is less likely to be caused by strep pneumo)
Legionella recommended in recent travel, legionella outbreak, severe CAP

Flu and COVID tests

Question 3

Antibiotics with atypical CAP coverage

Answer 3

Tetracyclines
Fluoroquinolones
Macrolides

Strep Pneumo is typical, cause 75% of cases

Question 4

What does the CURB-65 score tell you

Answer 4

Whether or not to admit the patient or discharge the patient.

C- Confusion
U- Uremia BUN >30
R- RR >30
B- BP <90 SBP or <60 DBP
Age >65

0-1: outpatient tx
2: Admit for observation
3<: Treat inpatient

Question 5

What does the PSI / PORT scale tell you

Answer 5

Considers factors above CURB 65, determines need for hospitalization in CAP pts

May underestimate severe PNA in healthy patients

Question 6

When to consider MRSA or Pseudomonas in PNA pts

Answer 6

• Prior isolate with either pathogen
• Hospitalization and tx with IV abx within 90 days

Pseudomonas: Cystic fibrosis, recurrent COPD exacerbations requiring steroids or abx, immunosuppression

MRSA: Post-influenza with severe or necrotizing pneumonia

Question 7

Outpatient Tx for CAP with no risk factors for MRSA, Pseudomonas, or comorbidities

Answer 7

• Doxycycline
• Amoxicillin
• Azithromycin/Clarithromycin

Question 8

Outpatient Tx for CAP with no risk factors for MRSA, Pseudomonas, and HAS comorbidities (Diabetes, heart, lung, liver, renal disease, alcoholism, immunosuppression)

Answer 8

• Augmentin or Cefuroxine AND doxycycline OR Azithro

OR

• Fluoroquinolone (Levofloxacin)

Comorbidities likely to grow GNR legionella or Catarrhalis, so need more than monotherapy

Question 9

Inpatient Tx for CAP, nonsevere

Answer 9

Ceftriaxone, unasyn, ceftaroline (B-lactam) AND Azithromycin/Clarithromycin ( Macrolide)

OR

Levofloxacin or moxifloxacin (Fluoroquinolone)

Question 10

Inpatient Tx for CAP, Severe

Answer 10

Ceftriaxone/unasyn (B-lactam) AND Azithromycin/Clarithromycin (Macrolide)

OR

Ceftriaxone/Unasyn (B-lactam) AND Levofloxacin or moxifloxacin (Fluoroquinolone)

Question 11

Which flouroquinolone should not be used in CAP

Answer 11

Ciprofloxacin- doesn’t cover abnormals in the lungs for respiratory infections

Question 12

When are corticosteroids recommended in CAP

Answer 12

• Asthma/COPD exacerbation
• Adrenal insufficiency
• Severe/Refractory septic shock

Question 13

MRSA coverage for CAP inpatient

Answer 13

Vanco or linezolid

Question 14

Pseudomonas coverage for CAP inpatient

Answer 14

Levofloxacin, cefepine/ceftazidime, Zosyn

Question 15

CAP outpatient coverage with comorbidities

Answer 15

Augmentin or cefuroxime and Doxy or Azithro

Question 16

Which outpatient Tx is best if you are concerned about QTc prolongation

Answer 16

Augmentin and Doxy (NOT floroquinolones)

Question 17

Key risk factor for VAP

Answer 17

Aspiration- Supine position, enteral nutrition, NG tube, use of antiacids etc

Question 18

HAP tx

Answer 18

Always cover Pseudomonas and MSSA
Cefepime/ ceftazidime/ imipenem/Zosyn/genta/tobra AND Vanco/Linezolid/

Question 19

VAP Tx

Answer 19

Always cover Pseudomonas and MSSA
Vanco/Linezolid and Zosyn (Peperacillin tazobactam)/ cefepime/ceftazidime/imipenem/maropenem/genta/tobra

Question 20

Duration of therapy for VAP/HAP

Answer 20

• Minimum of 7-8 days
• Afibrile for 48 hours
• Assess for stability

Question 21

What kind of pneumonia does aspiration typically lead to

Answer 21

Typically chemical pneumonitis, not usually infectious/bacterial

• Only treat with ABX if secondary infection (positive CXR esp RLL, Fever, Leukocytosis)