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risk factors of pneumonia
- > 65 years old
- immunocompromised
- recent treatment with abx
- comorbidities
- COPD
- cerebrovascular disease
- chronic renal disease
- diabetes
- heart failure
- hepatic disease
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clinical symptoms of pneumonia
- dyspnea
- tachypnea/tachycardia
- hypoxia
- rust-colored sputum
- chest radiograph or other imaging technique demonstrating infiltrate is REQUIRED
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procalcitonin
- elevated in presence of bacterial infection
- rises w/I 6-12 hrs of infection
- normal < 0.05 ng/mL
- treat when > 0.25
- take at initial presentation
- monitor days 3,5,7 for deescalation
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severity of illness score
- CURB-65
- Confusion
- Uremia
- Respiratory rate
- low Blood pressure
- age 65 years or greater
- 2 or more = hospitalization
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outpatient treatment for previously healthy, no risk factors for drug-resistant S. pneumoniae
- macrolide
- azithromycin
- clarithromycin
- erythromycin (more GI SE)
- alternate
- doxycycline
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risk factors for drug resistant S. pneumoniae
- chronic heart, lung, liver or renal disease
- alcoholism
- malignancy
- asplenia
- immunosuppressed
- use of antimicrobials w/I previous 3 months
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outpatient treatment if risk factors for drug-resistant S. pneumoniae
- respiratory fluoroquinolone
- moxifloxacin
- gemifloxacin
- levofloxacin
- OR
- beta-lactam + macrolide
- amoxicillin or augmentin preferred
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inpatient, non-ICU treatment of S.pneumoniae
- respiratory fluoroquinolone
- beta lactam + macrolide
- cefotaxime, cetriazone, ampicillin, ertapenem
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inpatient, ICU treatment of S. pneumoniae
- beta lactam + either azithromycin or FQ
- preferred: cefotaxime, cefepime, imipenem, meropenem
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5 criteria to switch from IV to PO
- hemodynamically stable
- improving clinically
- able to ingest medication
- normal function of GI tract
- clinical stability
- temp < 37.8
- HR < 100
- RR < 24
- SBP > 90
- O2 > 90
- normal mental status
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who should receive the influenza vaccine
> 6 months
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who should receive the pneumococcal vaccine
- > 65 yo
- current smokers
- high risk 2-64
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who should receive tetanus toxoid
19-64 yo
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definition of HAP
PNA that occurs > 48 hours after admission, not incubating at admission
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definition of CAP
PNA that does not meet any of the other definitions
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definition of VAP
PNA that arises > 48 hours after intubation
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definition of HCAP
- 1) hospitalized in acute care hospital for 2+ days within previous 90 days
- 2) resides in nursing home or long term care facility
- 3. IV abx, chemo or wound care w/I 30 days
- 4) attended hospital
- 5) attended hemodialysis clinic
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risk factors for MDR pathogens
- antimicrobial therapy in previous 90 days
- current hospitalization of 5+ days
- high rate of resistance
- risk factors for HCAP
- immunocompromised
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durations of therapy
we only need 7 days worth
if non-lactose fermenting P. aeruginos aro acinetobacter treat for 14 days
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FDA approval of aerosolized antibiotics
cystic fibrosis
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