The flashcards below were created by user
alvo2234
on FreezingBlue Flashcards.
-
types of pneumonia
- community acquired (CAP)
- Hospital acquired (HAP)
- Ventilator associated (VAP)
- health-care associated pneumonia (HCAP)
-
pneumonia has the greatest cause of death in what age group
children
-
what is the second most aqcuaired nosocomial infection
HAP (accounts for 25% of all ICU infections)
-
CAP has the highest incidence in which age group
children and adults
-
what are the clinical features for CAP
- cough
- fever
- sputum production
- pleuritic chest pain
-
are positive cultures needed for the diagnosis of pneumonia
diagnosis does not need required supporting microbiological data
-
what are the risk factors for CAP
- COPD
- smoking
- aspiration
- exposure to animal feces
- HIV
- previous travel
- flu season
- active flu in the patients community
-
when should a pneumonia pt be treat in outpatient care
if they have a PSI class I to II
-
when should a CAP pt be admitted into the hospital
- if they have a CURB-65 >= 2
- PSI class III to V
-
when should you admit a CAP pt in the ICU
- if the have severe pneumonia
- CURB-65 score >=3
-
which pathogens are seen in outpatient, inpatient ICU and non ICU
- s. pneumoniae
- h. influenzae
-
how do you define severe CAP
>=1 major or >=3 minor criteria
-
major criteria for CAP
- mechanical ventilation
- septic shock on vasopressors
-
what is CURB-65 criteria
- Confusion
- Uremia (BUN >=20)
- Respiratory rate (>=30)
- Blood pressure (<90 systolic or <60 diastolic)
- 65 years old or greater
-
diagnostic testing for outpatient CAP
identification for pathogens is optional
-
diagnostic testing for inpatient CAP
blood and sputum cultures
-
diagnostic testing for severe CAP
- blood cultures
- sputum cultures
- urinary antigen tests
-
what pathogens are tested in CAP in severe pts
- legionella pneumophila
- streptococcus pneumoniae
-
diagnostic testing for severe CAP pts with intubation
- blood cultures
- sputum cultures
- urinary antigen tests
- endotracheal aspirate
-
when is fungal and tuberculosis cultures indicated
cavitary infliltrates
-
when does the IDSA say a pt with CAP should receive antibiotic therapy if they are admitted to the ED
give the first dose in the ED
-
when does the HQA say that pts with CAP should recieve antibiotic therapy
initial anitbiotic therapy should be received within 4 hours of hospital arrival
-
empiric therapy for an outpatient CAP pt that was previously healthy
macrolide or doxycycline
-
empiric therapy for an outpatient CAP pt that has a comorbidities
FQN
-
empiric therapy for a CAP pt in the medical ward
- FQN
- beta-lactam plus macrolide
-
what are the respiratory FQN
-
empiric therapy for a CAP pt that is admitted into the ICU
- FQN
- beta-lactam plus azithromycin
-
MRSA empiric therapy for CAP should be covered if a pt has which of the following
- ICU admission
- necrotizing or cavitary lesions
- empyema
-
what is the recommended therapy for MRSA CAP pts
-
what is the preferred antibiotic for CAP pts with cultures showing s. pneumoniae
-
what is the first line agent for CAP pts with positive cultures for h.influenzae
Beta-lactams
-
what are the second line agents used to treat CAP pts with cultures positive for h.influenzae
-
which FQN has both antipseudomonal and pneumococcal coverage
levofloxacin
-
which cephalosporins are less effective for antipneumococcal coverage
cefuroxime
-
which macrolide antibiotics are rarely used due to poor tolerance
-
risk factors for poor tolerance of b-lactams
history of penicillin allergy
-
what are the risk factors for poor performance with macrolide abx
-
risk factors for toxicity and poor tolerance
- HF
- electrolyte imbalance
- prolonged QT
- CNS disorders
- concomitant steroids
-
risk factors for poor tolerance with AGs
- age
- concomitant diuretics
- age
-
duration of antibiotic therapy for CAP
- min of 5 days
- pt should be afebrile for at least 2 - 3 days
- should have no more than one sign of clinical instability
-
what is the first-line agent and how long is the duration of tx for outpatient treatment of previously healthy children and infants
amoxicillin (90mg/kg/day) for 10 days
-
who does the CDC recommend receive the pneumococcal vaccine
- anyone >65
- adults 19-64 with:
- chronic illness
- conditions that weaken the immune system
- cochlear implants or CSF leaks
- adults 19-64 who smoke
-
what are the pneumococcal vaccines for children and adults
- children; 13-valent
- adults; 23-valent
-
distinguishing between viral from bacterial pneumonia
bacterial infections are usually in adults and have a rapid onset and rate of response to antibiotic tx. they present with high fever and tachypnea (increase in WBC, C-RP, procalc)
viral infections are usually in children <5 and have a slow onset and slow/non response to antibiotics. pts present with rhinitis and wheezing and have a decrease in biomarkers.
-
when is recommended tx time for viral influenza CAP
- early as possible
- within 48 hours of symptom onset
- starting after 48 hours may still benefit pt
- tx should not what for lab confirmation of flu
-
which drug should be used when treating flu
- neuraminidase inhibitor:
- oseltamivir
- zanamivir
-
how long is the tx for CAP influenza
5 days but can consider for pts who remain severely ill
-
how long should a pt continue treatment on chemoprophylaxis for viral CAP
for 7 days after the last known exposure
-
how long should a person taking antiviral chemoprophylaxis continue on antiviral medication
until immunity after vaccination develops (usually about 2 weeks in adults and can take longer in children)
-
when is chemoprophylaxis not recommended
if it has been longer than 48 hours
-
dosing for tamiflu and relenza
- Tamiflu; tx 75 mg BID chemo 75 mg QD
- Relenza; tx 10mg (2 inhal) BID chemo QD
-
what are the CDC recommendations for viral pneumonia prevention
all person >=6 months old get vaccinated
-
what is the definition of HAP
occurs >=48 hours after hospital admission of a non-intubated patient
-
definition of VAP
pneumonia that arises >= 48 - 72 hours after endotracheal intubation
-
definition of HCAP
- pneumonia that occurs <=48 hours of admission with the presence of;
- 1. has received IV antibiotics, hemodialysis, chemo, or wound care
- 2. in the last 90 days, hospitalized >1 day
- 3. ever resided in nursing home or long-term care facility
-
what is the clinical dx for HAP
- new or progressive radiographic infiltrate
- plus at least two or three clinical features;
- 1. fever > 38C
- 2. leukocytosis
- 3. leukopenia
- 4. purulent secretions
-
time onset of CAP and HCAP
within 48 hours
-
time onset of early onset HAP and VAP
48 to 120 hours after admission
-
when is late on set HAP and VAP
5 or more days after admission
-
common aerobic gram-negative bacilli pathogens for HAP
- p. aeruginosa
- e.coli
- klebsiella pneumoniae
- acinetobacter species
-
common gram-positive cocci pathogens for HAP
s. aureus
-
what are the risk factors for HAP s. aureus
- DM
- head trauma
- admission to the ICU
-
initial therapy for HAP should be which route of administration
IV and then can transition to PO as appropriate
-
what is the coverage required for early onset (<=4th day) HAP with no risk factors and cultures postive for gram negative bacilli
- only one agent(does not pseud activity)
- ceftriaxone
- respiratory FQN
- unasyn
- ertapenem
-
what is the coverage required for early onset HAP with no risk factors and cultures positve for MRSA
not required
-
what is the coverage required for a pt with late onset HAP or risk factors with cultures positive for gram negative bacilli
- two antipseudomonal agents used:
- ceph, carbapen, B-lactam/b-lactamase Inhi
- +
- antipseudomonal FQN or AG
-
what are the antipseudomonal FQN
- levofloxacin
- ciprofloxacin
-
MRSA coverage required for pts with late onset HAP or risk factors
linezolid or vancomycin
-
which pathogen can produce ESBL
enterobacter
-
which antimicrobial agent is enterobacter resistant to
first through third cephalosporins
-
what are the most effective agents used to treat acinetobacter species
- carbapenem
- sulbactam
- polymyxins
-
what should the vancomycin troughs be for pneumonia
15 - 20 ug/mL
-
what has been found to be a comparable option to vancomycin
linezolid
-
which agent, which is normally a viable option for MRSA, is not used
daptomycin, not active in the lung tissue
-
duration of therapy for uncomplicated HAP mgmt without pseudomonas
7-8 days is recommended
-
complications from HAP
- empyema
- lung abscess
- c. difficile
- occult infection
- drug fever
|
|