CAP
Define CAP
Pneumonia infection diagnosed as outpatient or within 48 hours of hospital admission
MC bug etiologies for HAP/VAP
SPUTUM: ID bug
1. Rusty colored sputum
2. Currant jelly (purple/red) sputum
1. Strep. pneumoniae
2. Klebsiella pneumoniae
What bug is associated with rusty-colored sputum?
Strep pneumoniae
MC bug etiology for aspiration pneumonia
Anaerobes
MC bug in CAP
Strep pneumoniae
When treating HAP/VAP, what should be considered?
1. Institutional risk factors - antibiograms
2. Individual risk factors for multidrug-resistant pathogens
MC atypical cause of pneumoniae in children
Viruses
ID typical bugs
1. Strep pneumoniae
2. H. influenzae
3. Staph aureus
4. Klebsiella pneumoniae
Risk factors for aspiration pneumonia
Swallowing issue:
1. Alerted state from drug or alcohol use
2.
Average duration of treatment
5 days
When should a second anti-pseudomonas agent be added for tx of HAP/VAP?
IV abx in last 90 days (add another anti-pseudo agent w/ different MOA)
Lung Exams for Typical v.s. Atypical Pneumonia
Typical: dullness to percussion, bronchial breath sounds, increased tactile fremitus, + special tests, late inspiratory crackles
Atypical: poss crackles
ID atypical bugs
1. Mycoplasma pneumoniae
2. Chlamydophila pneumoniae
3. Legionella
4. Viruses (RSV, influenzae, etc.)
Which institutional tool should guide empiric antibiotic choice for HAP and VAP?
Local antibiogram
A healthy 33-year-old has outpatient CAP in a region where macrolide resistance is 35 percent and has a severe amoxicillin allergy. Which listed option fits?
Doxycycline
A VAP patient is on cefepime, tobramycin and vancomycin. At 72 hours, cultures grow cefepime-susceptible Pseudomonas, blood cultures are negative, and the MRSA nasal PCR is negative. What is the next step?
Narrow to cefepime alone
A 70-year-old with a prior stroke has a weak cough and impaired airway clearance and develops CAP. Which mechanism best explains her susceptibility?
Impaired cough reflex and mucociliary clearance
After a cruise, a 67-year-old has pneumonia with watery diarrhea and vomiting. Which organism fits best?
Legionella pneumophila
TX for aspiration pneumonia
Broad-spectrum beta-lactam:
1. Ampicillin-sulbactam (IV)
2. Amoxicillin-clavulanic acid (PO)
A 37-year-old who had a splenectomy after trauma has outpatient CAP. Which regimen fits?
Beta-lactam w/ broad coverage + macrolide or DOXY OR fluoroquinolone as monotherapy (reserved)
Cefpodoxime plus azithromycin
OR
Augmentin plus doxy
A HAP patient on fluoxetine needs MRSA coverage. Which concern applies if linezolid is chosen?
Serotonergic interactions
Several healthy military recruits develop low-grade fever, dry cough and fatigue over a week. Their CXRs show a reticulonodular pattern. Which organism is most likely?
Mycoplasma pneumoniae
An 81-year-old with severe COPD develops typical pneumonia. Besides S. pneumoniae, which typical organism is classically linked to her age and lung disease?
Haemophilus influenzae
CURB-65 criteria
C: confusion
U: urea >7mmol
R: respiration rate >/= 30
B: bp >/=90 (systolic) or >/= 60 (diastolic)
65: >65 years old