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What is URTI?
Nonspecific term to describe acute infx involving the nose, paranasal sinuses, pharynx, and larynx
common cold (viral)
most common reason for MD visits in U.S.
URTI is mostly caused by what? What are other causes?
…
In Rhinosinusitis, when do we treat with ABX?
Persistent signs or symptoms of acute rhinosinusitis, lasting for >10 days (Viral sinusitis usually lasts only 7-10 days) without any evidence of clinical improvement.
Worsening signs or symptoms characterized by new-onset fever, headache, or increase in nasal discharge following a viral cold or flu that lasted ~7 days, and were initially improving but developed the above signs and/or symptoms
Severe signs or symptoms; high fever (≥39°C [102°F]), purulent nasal discharge, or facial pain lasting for at 3 to 4 consecutive days at the beginning of illness
What is first line tx for Sinusitis?
Amox/clav x5-7d
Doxycycline, beta-lactam allergy
What is second line tx for sinusitis?
High dose amoxicillin/clav x5-7 d
Respiratory FQ (Moxifloxacin, Levofloxacin)
Pneumonia inflammation occurs where?
within the lung tissue, bronchioles, and alveoli
fluid/mucus build up in the alveoli and can interfere with gas exchange → decrease in O2 saturation
Bronchitis is inflammation of what?
Bronchitis is inflammation of the lining of the bronchi. Rarely fluid/mucus in the alveoli.
Chronic bronchitis prolonged inflammation & secretions may hinder O2 exchange.
How are pathogens acquired in pneumonia?
via aspiratio
Saliva (oral flora or oral colonizers)
Stomach contents
via inhalation of aerosolized particles
seeding from the bloodstream
Lung defenses protect from pneumonia but can still occur if what?
Patient is immunosuppressed
Celia defense mechanisms not working
Inoculum of bacteria is too high and overwhelms the defenses
Viral infection → weakens immune system/lung defenses
What are some risk factors on pneumonia?
Smoking
PPI use
Structural lung disease
Prolonged hosptitalization
Contaminated water supply
Immunosuppression (steroids, chemo, elderly)
What are signs+sx of pneumonia? What about labs need to be taken and physical exam signs?
Sx: Dyspnea, productive cough, fever, Chest pain
Labs: WBC with differential: PMNs, Elevated bands (“left shift”)
Low oxygen (O2) saturation
Pro-calcitontin levels (Pct)
C-reactive protein (CRP)
Physical: tachypnea, tachycardia, inspiratory crackles, rales, rhonchi, wheezing
What are some ways to diagnose pneumonia?
Chest X-Ray (CXR)
Presence of infiltrates, consolidation, or pleural effusions
Sputum Gram-stain/cultures
Not routinely done for outpatients
Recommended for some inpatients (severe CAP (or MDRO risk), HAV/VAP)
bronchoalveolar lavage (BAL) sometimes needed
Blood cultures – for some patients (severe infection)
Routine lab testing – CBC, BMP, LFTs, Procalcitonin, CRP
Pulse oximetry, ABG
In a sputum culture, what is optimal specimen vs bad specimen?
Optimal specimen
< 10 epithelial cells / hpf
> 25 WBCs / hpf
A predominant organism on Gram stain
Heavy growth of a single species on culture
Non-optimal (bad) specimen
> 10 epithelial cells / hpf
< 25 WBCs / hp
Several organisms → normal flora
Lack of a single predominant organism
PROCALCITONIN SLIDE
What is the PCT algorithm for stewardship of antibiotic therapy in patients with LRTI?
Insert
What are the different classifications of pneumonia?
Community Acquired Pneumonia (CAP)
Atypical Pneumonia
Hospital Acquired Pneumonia (HAP) → nosocomial
Ventilator Associated Pneumonia (VAP) → nosocomial
Aspiration Pneumonia
Where does community acquired pneumonia occur?
Non-hospitalized patient (patient in community setting)
Acquired infection while in the community
Pneumonia symptoms present < 48 hours after admission (suggests patient came in with it)
What is known about the info of CAP?
Infection/inflammation of the pulmonary parenchyma
Acute infection
When determining outpatient vs inpatient tx, what can it be based on?
PSI (preferred)
CURB65
What is the major criteria for severe CAP?
Invasive mechanical ventilation
Septic shock - need of vasopressors
**One of these
What is the #1 cause of CAPB?
Strep pneumoniae
What is the DOC for inpatient CAP?
3rd gen cephalosporins (ceftriaxone)