PNEUMONIA

Question 1

What are the 3 types of pneumonia?

Answer 1

Community acquired

Hospital acquired

Aspiration

Question 2

How do we determine if someone with CAP should be treated in patient or outpatient?

Answer 2

Based off of their CRB-65 score + Confusion OR Resp. Rate greater than 30 OR BP less than 90 systolic

• One or more of those additional items is present → Inpatient management
• Hypoxia = automatic admission

Question 3

Is Abx use for pneumonia empiric or based off of culture?

Answer 3

Empiric

Question 4

What are the most frequently isolated pathogens for CAP?

Answer 4

Strep pneumoniae, Mycoplasma pneumoniae, Chlamydia pneumonia, and respiratory values

Question 5

How do we manage CAP?

Answer 5

Levofloxacin

OR

Ceftriaxone + Azithromycin (macrolide)

Question 6

What are some adjunct treatments for CAP in the hospital?

Answer 6

O2, nebulized inhalants, steroids (possibly due to immunosupression)

Question 7

What do we need to continue to monitor during the patient’s stay for pneumonia?

Answer 7

VITALS! (fever, BP, tachycardic/pnea)

Daily labs = CBC, BMP, and follow blood cultures!

*AKA monitor if they’re going into sepsis

Question 8

is repeat imaging needed in someone with pneumonia?

Answer 8

Not needed if clear clinical improvement

If not improving - concern for lung abscess or empyema – do a CT

Question 9

How would we know if someone had HCAP?

Answer 9

Pneumonia in a hospitalized patient

OR nonhospitalized patient with one or more of:
Recent IV, wound care within 30 days
Nursing home residence
Hospitalization in an acute care hospital for 2+ days within past 90 days
Occurs 48 hours+ after admission = nosocomial pneumonia
Occurs 48-72 hours after endotracheal intubation = ventilator associated pneumonia

Question 10

Almost all abx use in pneumonia is _____

Answer 10

EMPIRIC**

Question 11

When do we see multidrug resistant pneumonia?

Answer 11

HCAP

Question 12

Received Abx in the past 90 days, current hospitalization x 5+ days, high frequency Abx resistance in the community, Immunosuppressive disease (receiving CA treatment, steroids, immunomodulating meds), and severe septic shock at all signs of what?

Answer 12

Multidrug resistance

*Only need one of those

Question 13

What meds do we use to treat HCAP without the risks of multidrug resistance?

Answer 13

Ceftriaxone OR Levoquin/Avelox

Question 14

How do we treat HCAP with MDR risk?

Answer 14

“Triple Abx therapy”

Zosyn + Floroquinolones + Vanco → ALL IV (Picc line is best)

Question 15

What is the length of stay for HCAP?

Answer 15

7 days minimum – IV Tx

Can consider to PO meds if clinical response to IV after 48-72 hours

Question 16

If a patient aspirates their own gastric acids – what does that cause?

Answer 16

Pneumonitis (it’s been burned so a bacteria can set in)

Question 17

How do we treat aspiration pneumonia?

Answer 17

Clindamycin IV

**KEEP PATIENT NPO until speech therapy can evaluate and recommend safe swallowing

Question 18

SO what should we remember about pneumonia?

Answer 18

Identify the type

Appropriate empiric Abx regimen

If aspiration – strict NPO until speech therapy can evaluate

Question 19

If a diabetic/hypertensive patient comes in with SOB, fatigue, wheeze and sputum culture. Ambulation increased her work of breathing and air hunger – what diagnosis?

Answer 19

CAP