pulm infectious disease Flashcards
(22 cards)
What are the two major criteria for admitting to ICU with CAP?
septic shock w/ need for vasopressor support and respiratory failure w/ need for mechanical ventilation
What are the minor criteria for admission to ICU with CAP?
- RR 30+
- hypoxemia
- hypothermia
- hypotension requiring aggressive fluid resuscitation
- confusion/disorientation
- multi-lobar pulmonary opacities
- leukopenia
- thrombocytopenia
- uremia
- metabolic acidosis
- elevated lactate level
What is general criteria is required for admission to ICU with CAP?
one major criteria or 3+ minor criteria should be in ICU and consider other patient factors
What score should you look at considering admission with pneumonia?
CRB-65 score
What CRB-65 score means urgent admission?
3-4
What are the CRB-65 criteria?
Confusion
RR >30
BP <90 SBP <60 DBP
Age>65 years
How do you treat acute bronchitis?
supportive treatment and recommend throat lozenges, hot tea, smoking cessation, humidifier, gen OTC meds
When should you admit a CAP patient?
CRB-65 – Confusion, RR >30, BP<90 or <60, >65y.
If 1or 2, consider admission. If 3 or 4, urgent admission
When should you consider hospitalization for CAP?
Infant < 6 mo old with bacterial pneumonia,
concern for pathogen w/ increase virulence (ex. MRSA),
concerns about caregiver or pt following recommendations or recognizing symptom progression,
comorbidities
AND CRB-65 SCORE!
How do you treat CAP outpatient who have not taken abx within 3 months and not in area of high resistance?
macrolide (azithromycin or clarithromycin), doxycycline, amoxicillin
How do you treat CAP outpatient in high risk for drug resistance patients outpatient?
macrolide (azithromycin or clarithromycin) + beta lactam (augmentin or amoxicillin or cephalosporin).
or a respiratory fluoroquinolone
How do you treat CAP inpatient?
macrolide (azithromycin or clarithromycin) + beta-lactam (ceftriaxone or ceftaroline)
or respiratory fluoroquinolone
How do you treat CAP inpatient in the ICU?
antipneumo beta-lactam ( cefotaxime, ceftriaxone, ceftaroline or amp-sulb )+ azithro.
or antipneumo beta-lactam ( cefotaxime, ceftriaxone, ceftaroline or amp-sulb )+ respiratory fluoroquinolone
What are some other specific situation ICU CAP treatments?
PCN allergy = fluoroquinolone + aztreonam
pseudomonas = antipneumococcal + antipseudomonal beta lactam (piperacillin-tazobactam, cefepime, imipenem, meropenem) + fluoroquinolone or azithromycin.
MRSA = add linezolid or vancomycin
What is empiric treatment based upon in nosocomial pneumonia?
empiric with
- risk of MRSA, MDR, psuedomonas, other g- bacilli
- drug resistance
- local antibiograms
- mortality risk
it’s usually ~ 7 days long
How do you treat mycoplasma pneumonia?
self-limiting so usually doesn’t require treatment but if you want some,
macrolide (azithro) or doxycycline or levofloxacin
If nonsevere inpatient, respiratory fluoroquinolone or beta lactam w macrolide
How do you treat serious mycoplasma pneumonia?
respiratory fluroquinolone or beta-lactam + macrolide
How do you treat legionella pneumonia?
azithromycin, clarithromycin, or fluoroquinolone (levofloxacin)
How do you treat anaerobic pneumonia?
beta-lactam/lactamase inhibitor combo:
piperacillin-tazobactam or amoxicillin-clav OR carbapenem
continue until CXR improve
empyema –> tube thoracostomy or open pleural drainage
How do you treat RSV/acute bronchiolitis?
time! respiratory isolation, tube feeding or IV nutrition if unable to feed
support w nasal suction, airway management, hydration, humidifier
high risk = aerosolized ribavirin
What’s prophylaxis for aspergillosis?
posaconazole or voriconazole
What’s treatment for aspergillosis?
IV voriconazole
