Bugs & Drugs
This bug is the most common cause of community acquired pneumonia (CAP). Usually suspected in middle-aged adults and the elderly.
What is streptococcus pneumoniae
Definition of CAP
What is pneumonia contracted outside of the healthcare system
The CURB-65 score is based upon these five easily measurable factors from which its name is derived
What is:
Confusion, Urea, Respiratory rate, BP, Age > 65
Due to the ease of oral formulation, fluoroquinolones are often prescribed as outpatient treatment of pneumonia. You might want to evaluate this prior prescribing, particularly among the psych population.
What is QT interval
Referred to as our respiratory fluoroquinolones due to their penetration into the lungs
What are moxifloxacin, gemifloxacin, and levofloxacin
The criteria that defines HAP and VAP
What is
pneumonia that occurs > 48 hours after patient has been admitted to hospital (HAP)
a type of HAP that develops more than 48 hours after endotracheal intubation (VAP)
A CURB 65 score of this value is indicated for the treatment of pneumonia outpatient
What is 0-2
Some forms of CAP can be prevented by these vaccinations and should be recommended in these patients. Name the vaccines and criteria for indication
What are:
- Annual flu shot and pneumococcal vaccine
- indicated for all patients ≥65 years old and others with specific risk factors (eg, certain comorbidities including chronic heart, lung, and liver disease, immunocompromising conditions, and impaired splenic function)
Due to their bacterial cell structures, these bugs are referred to as "atypical" because they do not color when gram stained.
What is Legionella, chlamydia, mycoplasma
The risk factors for MDR pathogens (including pseudomonas)
What are:
●IV antibiotic use within the previous 90 days
●Septic shock at the time of VAP
●Acute respiratory distress syndrome (ARDS) preceding VAP
●≥5 days of hospitalization prior to the occurrence of VAP
●Acute renal replacement therapy prior to VAP onset
Possible signs and symptoms seen with CAP
What are dyspnea, hypoxemia, chest discomfort
This respiratory co-morbidity is often confused with pneumonia due to similar presenting signs and symptoms. Thorough discussion with the medical team should be done prior to jumping to antibiotics
What is COPD exacerbation
This third-generation cephalosporin is unique amongst its generational class due to its chemical structure that confers stability to β-lactamase enzymes produced by many Gram-negative bacteria allowing it to cover pseudomonas
What is ceftazidime
HAP/VAP occasionally require two double pseudomonal coverage if meeting these criteria
What are
- prior IV antibiotic use within 90 days
- septic shock
- ARDS
- patients in units where >10% of gram-negative isolates are resistant to an agent being considered for monotherapy
- patients in an ICU where local antimicrobial susceptibility rates aren't available
- if the patient has structural lung disease such as bronchiectasis or cystic fibrosis.
A CURB 65 score of this value is indicated for the treatment of pneumonia inpatient
What is 3-5
This serum biomarker can be evaluated to distinguish a bacterial infection from other causes of infection or inflammation. I should not be used to decide for the initiation of antibiotics
What is procalcitonin
Common organisms associated with immunocompromised patients (ie HIV, transplant, neutropenia)
What is S. aureus, P. aeruginosa, Stenotrophomonas maltophilia, and Burkholderia cepacia complex
This type of pneumonia may occur if a person breathes something in rather than swallowing it. The IDSA does not recommend the routine use of anaerobe coverage in these pneumonias
What is aspiration pneumonia
This clinical assessment tool is another alternative commonly used to calculate the probability of morbidity and mortality among patients with community acquired pneumonia. It's mortality prediction is similar to that of CURB-65
What is the pneumonia severity index (PSI)
You are rounding on a patient that has been mechanically ventilated for 53 days in the ICU with COVID-19 and PMH of cystic fibrosis. The patient is currently on empiric cefepime for treatment of pneumonia. The patient's sputum culture is reported from the microbiology lab as non mucoid colonies. This patient has had a previous infection with pseudomonas aeruginosa (sensitive to cefepime) and MRSA bacteremia. Patient is spiking 103 fevers and WBC is 36. What antibiotic is recommended?
What are meropenem and vancomycin