Pneumonia and CAP

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44 Terms

1

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.

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2

URTI is mostly caused by what? What are other causes?

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3

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

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4

What is first line tx for Sinusitis?

  • Amox/clav x5-7d

  • Doxycycline, beta-lactam allergy

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5

What is second line tx for sinusitis?

  • High dose amoxicillin/clav x5-7 d

  • Respiratory FQ (Moxifloxacin, Levofloxacin)

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6

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

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7

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.

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8

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

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9

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

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10

What are some risk factors on pneumonia?

  • Smoking

  • PPI use

  • Structural lung disease

  • Prolonged hosptitalization

  • Contaminated water supply

  • Immunosuppression (steroids, chemo, elderly)

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11

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

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12

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

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13

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

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14

PROCALCITONIN SLIDE

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15

What is the PCT algorithm for stewardship of antibiotic therapy in patients with LRTI?

  • Insert

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16

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

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17

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)

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18

What is known about the info of CAP?

  • Infection/inflammation of the pulmonary parenchyma

  • Acute infection

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19

When determining outpatient vs inpatient tx, what can it be based on?

  • PSI (preferred)

  • CURB65

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20

What is the major criteria for severe CAP?

  • Invasive mechanical ventilation

  • Septic shock - need of vasopressors

  • **One of these

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21

What is the #1 cause of CAPB?

  • Strep pneumoniae

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22

What is the DOC for inpatient CAP?

  • 3rd gen cephalosporins (ceftriaxone)

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