Definitions
Hospital-acquired pneumonia can be diagnosed if a patient presents with s/sx of pneumonia and a chest X-ray with infiltrates this long after they have been admitted to the hospital.
What is 48 hours?
Pneumonia is only prevalent from October to May.
False.
The most common pathogen cause of community-acquired pneumonia.
What is Streptococcus pneumoniae?
JM is a 65-year-old male with PMH of HTN, dyslipidemia, and diabetes who presents to SNGH ED complaining of 1 day of chills, consistent cough, and "trouble getting a full breath in." He presents with a fever of 101.4°F and exhibits crackles upon auscultation of the lungs. His last hospital visit was 2 years ago when two of his left fingers were amputated. This is the type of pneumonia JM has.
What is community-acquired pneumonia?
JM is a 65-year-old male with PMH of HTN, dyslipidemia, and diabetes who presents to SNGH ED complaining of 1 day of chills, consistent cough, and "trouble getting a full breath in." He presents with a fever of 101.4°F and exhibits crackles upon auscultation of the lungs. His last hospital visit was 2 years ago when two of his left fingers were amputated.
Assuming this patient has been diagnosed with non-severe CAP, this patient should be treated with:
A. Unasyn 2g IV Q6
B. Ceftriaxone 1g IV Q24
C. Unasyn 2g IV Q6 + Levofloxacin 750 mg IV Q24
D. Unasyn 2g IV Q6 + Doxycycline 100 mg IV Q12
What is D? (B-lactam + Atypical coverage)
This is a type of pneumonia that develops more than 48-72 hours after endotrachial intubation.
What is ventilator-associated pneumonia (VAP)>
Empiric MRSA treatment for HAP using IV vancomycin or IV linezolid should be used if a patient was previously given a course of IV antibiotics within the last 4 months of their current presentation.
False
90 days (3 months)
These are the pathogens we additionally cover for if a patient is diagnosed with HAP or VAP.
What are Staphylococcus aureus, Pseudomonas aeruginosa, and gram-negative bacilli?
SL is a 56-year-old female with a PMH of cystic fibrosis and Lyme disease who presents to SNGH ED complaining that she cannot catch her breath. Upon admission, you notice she is confused and disoriented because she cannot form coherent sentences and seems to lose track of her thoughts. After initial examination and lab work, you gather the following objective information:
T 99.1°F, BP 100/70 mmHg, HR 104 bpm, RR 32 rpm, WBC 10,000, BUN 15 mg/dl, Plt 15,000.
She required aggressive fluid resuscitation to correct hypotension.
This is the type of pneumonia SL has.
What is severe CAP?
-Three minor criteria met: RR 30+, confusion/disorientation, and hypotension requiring aggressive fluid resuscitation.
PS is a 65-year-old male with a PMH of cystic fibrosis who has been mechanically ventilated in the ICU for the past 4 days post-TBI. On day 4 of his admission, you collect the following objective information:
BP 115/80, HR 75 bpm, WBC 45,000, new-onset fever of 101.2°F, increased oxygen requirements on the ventillator, and increased secretions from the endotracheal tube. Assuming this patient has ventillator-acquired pneumonia, which treatment is appropriate to cover for Pseudomonas aeruginosa:
A. Zosyn IV 4500 mg Q6
B. Zosyn IV 3375 mg Q6
C. Zosyn IV 4500 mg Q6 + Ciprofloxacin IV 400 mg Q8
D. Zosyn IV 3375 mg Q6 + Ciprofloxxacin IV 400 mg Q8
What is C?
Zosyn Pseudomonas dosing + Non-beta-lactam Pseudomonas coverage
This is an adjunct to severe CAP treatment in the ICU that was shown to decrease mortality in this patient population.
What is IV hydrocortisone?
Empiric MRSA treatment for VAP should be initiated if a patient has been admitted for the past 7 days even if they do not have s/sx of pneumonia.
False.
This is the pathogen responsible for what we call "walking pneumonia".
What is Mycoplasma pneumoniae?
PS is a 65-year-old male who has been mechanically ventilated in the ICU for the past 4 days post-TBI. On day 4 of his admission, you collect the following objective information:
BP 115/80, HR 75 bpm, WBC 45,000, new-onset fever of 101.2°F, increased oxygen requirements on the ventillator, and increased secretions from the endotracheal tube. This is the type of pneumonia PS has.
What is ventilator-associated pneumonia?
SL is a 56-year-old female with a PMH of cystic fibrosis and Lyme disease who presents to SNGH ED complaining that she cannot catch her breath. Upon admission, you notice she is confused and disoriented because she cannot form coherent sentences and seems to lose track of her thoughts. After initial examination and lab work, you gather the following objective information:
T 99.1°F, BP 100/70 mmHg, HR 104 bpm, RR 32 rpm, WBC 10,000, BUN 15 mg/dl, Plt 15,000.
She required aggressive fluid resuscitation to correct hypotension. Assuming this patient has severe CAP, which is the following is the appropriate antibiotics treatment:
A. Levofloxacin 750 mg IV Q24
B. Ceftriaxone 2g IV Q24
C. Ceftriaxone 2g IV Q24 + Unasyn 2 g IV Q6
D. Ceftriaxone 2 g IV Q24 + Levofloxacin 750 mg IV Q24
What is D?
Fluroquinolones are an option used in combination with beta-lactams, as opposed to just monotherapy for non-severe CAP.
This is the classification of pneumonia that occurs when a patient presents with the appropriate s/sx and has not had any recent hospitalizations, but presents with septic shock and needs vasopressors for hemodynamic instability.
What is severe CAP?
Procalcitonin is a biomarker that can be used to help gauge when antibiotics should be discontinued.
True
This is the pathogen that the IDSA guidelines recommend double coverage for in patients with HAP or VAP who have risk factors for resistance or structural lung disease.
Pseudomonas aeruginosa
JB is an 18-year-old male who has been admitted to the general floor since this morning, recovering from a splenectomy. This afternoon, he has developed a persistent cough with new-onset increased sputum production and is complaining of new chest pain. He has a new onset fever of 100.9°F that he did not have a few hours ago. A chest X-ray was ordered, and it showed pulmonary infiltrates that were not on his previous chest X-ray. This is the type of pneumonia this patient has.
What is community-acquired pneumonia?
MS is a 40-year-old female who has been diagnosed with non-severe CAP. Prior to her current admission, she was hospitalized and treated for a MRSA soft skin and tissue infection 4 months ago. Allergies include vancomycin. Which of the following is the appropriate antibiotic to start for MRSA coverage?
A. Cefepime 2g IV Q8
B. Zosyn 4500 mg IV Q6
C. Vancomycin 125 mg PO Q6
D. Linezolid 600 mg IV Q12
What is D?
These are the antibiotics we use to cover for Pseudomonas aeruginosa in CAP. (5)
What are Zosyn, Cefepime, Ceftazidime, Imipenem, and Meropenem?
False
This is the pathogen responsible for a severe form of pneumonia that can cause very high fevers of 104°F or higher, muscle aches, nausea, vomiting, diarrhea, and confusion.
What is Legionella pneumophilia?
BS is a 57-year-old male who has been admitted to the ICU for the last 3 days due to his need for CRRT. Due to unexpected complications, BS needed to be intubated on Day 4 of his admission. On Day 5 while on the ventillator, BS's WBC count becomes elevated to 20,000, new onset T 100.5F, and the nurse reports a lot of sputum from the endotracheal tube in the last few hours. Chest x-ray shows new pulmonary infiltrates. This is the type of pneumonia this patient has?
What is hospital-acquired pneumonia?
BS is a 57-year-old male who has been admitted to the ICU for the last 3 days due to his need for CRRT and septic shock with need for vasopressors. BS needed to be intubated on Day 4 of his admission. On Day 5 while on the ventillator, BS's WBC count becomes elevated to 20,000, new onset T 100.5F, and the nurse reports increased sputum from the endotracheal tube in the last few hours. Chest x-ray shows new pulmonary infiltrates. Assuming this patient has hospital-acquired pneumonia, which regimen is appropriate to start in this patient?
A. Vancomycin IV per institutional protocol + Ceftriaxone 2g IV Q24
B. Vancomycin IV per institutuonal protocol + Zosyn 3375 mg IV Q6
C. Linezolid 600 mg IV Q12 + Cefepime 2g IV Q8
D. Linezolid 600 mg IV Q12 + Zosyn 3375 mg IV Q6
What is C?