Flu and atypicals
Name one indication for legionella urinary antigen testing in CAP
Severe pneumonia or current outbreak
Name 2 out of 3 recommended antibiotics (not including doses) for outpatient pneumonia treatment in a patient without significant comorbidities. Hint: these are all monotherapy.
Amoxicillin, doxycycline, azithromycin (depending on resistance patterns)
True or false: patients with suspected aspiration pneumonia should be routinely treated with coverage for anaerobic pathogens.
False (unless empyema or suspected abscess)
True or false: follow up chest XR is not routinely recommended for a patient with resolution of symptoms within 5-7 days.
True
When should you routinely test for influenza in a patient with pneumonia?
A. Never
B. Always
C. when influenza is actively circulating in the community
C
Name a possible treatment regimen for uncomplicated inpatient pneumonia
unasyn/3rd gen cephalosporin + azithromycin/doxy respiratory fluoroquinolone
What is the minimum recommended duration of treatment for CAP?
(5 days)
In a patient with possible CAP, how does procalcitonin affect the decision to initiate antibiotics?
If suspicion is high, antibiotics should not be withheld based on procalcitonin level.
In what clinical scenario should pneumonia urinary antigen be routinely obtained for CAP?
I will accept "never" or "could be considered in severe pneumonia"
A patient presenting from a nursing home with no recent hospitalization or antibiotics should be treated with which of these in an inpatient setting for pneumonia:
A. standard CAP regimen
B. standard regimen + MRSA coverage
C. standard + pseudomonas coverage
D. Standard + MRSA + pseudomonas
A. "Healthcare associated pneumonia" is no longer endorsed as a pneumonia category, so this patient should be treated like any CAP patient.
In an inpatient with no significant comorbidities, when could steroid treatment be considered in addition to CAP coverage?
A. nonsevere CAP
B. Severe influenza PNA
C. severe CAP
D. Severe CAP with refractory shock
E. Both C & D
E
Name 2 indications to get sputum and/or blood culture in pneumonia
severe CAP
intubated
empiric tx for or previous infection with MRSA or pseudomonas
hospitalized with parenteral abx in last 90 days
When should a patient with CAP with + influenza be treated with antibacterial therapy?
A. All patients
B. All inpatients
C. All outpatients with radiographic evidence of PNA and all inpatients
D. All patients with radiographic evidence of PNA
D
Name 2 possible antibiotic regimens for outpatient adults with comorbidities such as chronic heart, lung, liver, or renal disease; diabetes mellitus; alcoholism; malignancy; or asplenia
augmentin + azithro/doxy
3rd gen ceph +azithro/doxy
Resp fluoroquinolone
Name one of 2 major criteria for determining severe pneumonia based on IDSA guidelines.
septic shock requiring pressors, need for ventilation
DAILY DOUBLE!
After determining if a patient with CAP is severe or nonsevere, there are 5 factors that should be evaluated to consider need for additional antibiotic coverage. Name at least 3.
Prior MRSA isolation
Prior pseudomonas isolation
Recent hospitalization w/ parenteral antibiotics
Risk factors for MRSA
Risk factors for pseudomonas
For patients with CAP and + influenza test, when should antiviral therapy be given?
A. to inpatients regardless of duration of symptoms
B. to inpatients presenting within 48 hours of symptom onset
C. To inpatients regardless of duration and outpatients within 48 hours of symptom onset
D. To all patients regardless of duration of symptoms
D
Which is not an appropriate regimen for treatment of a patient with severe inpatient pneumonia and no MRSA or pseudomonal risk factors:
A. Levofloxacin + azithromycin
B. Ceftriaxone + azithromycin
C. Levofloxacin + ceftriaxone
D. Unasyn + azithromycin
A
How many minor criteria are required to determine presence of severe pneumonia potentially warranting ICU admission?
3
What decision making tool for determining inpatient vs outpatient management of pneumonia is preferentially recommended by the IDSA?
Pneumonia severity index (PSI)
Name as many minor criteria for severe pneumonia as you can. 300 points for each correct answer (or in the ballpark), no penalty for incorrect answers
RR>30
PAO2:FIO2 ratio <250
Multilobar infiltrates
Confusion/disorientation
BUN >20
WBC < 4k
PLT <100k
T < 36 C
Hypotension requiring aggressive fluid resuscitation