Etiology/Pathology
What is the difference between CAP and HAP?
CAP = minimal/no recent healthcare exposure or contact (less than 48h)
HAP = PNA that develops at least 48 hours following hospitalization (VAP = 48h after intubation)
Cough, Chest Pain, Dyspnea, Fever, Malaise
Atypical: Headache, confusion, diarrhea, CV sx, Skin sx
What are the differences associated with the 2007 and 2019 IDSA guidelines for CAP?
Identification of patient populations for sputum and blood culture, HCAP removed as a term (just CAP), treatment recommendations
What are risk factors for aspiration PNA?
Elderly, impaired consciousness, lung dx, seizure disorder, stroke, dental issues, dementia, swallowing dysfunction
What is the duration of therapy for CAP?
Per IDSA, patient should be afebrile x 48h and receive antibiotic therapy for at least 5 days
What are risk factor associated with CAP?
<5yo, >65 yo, Alcoholism; Aspiration; Smoking; Hx of COPD; Exposure to others who are sick; Exposure to animals/farms; HIV; Recent travel; Genetic factors
How is severe CAP defined?
IDSA guidelines have major and minor criteria
What are options for outpatient treatment for CAP?
Amoxicillin + Macrolide or Doxycycline (most pt)
Augmentin + Macrolide or Doxycycline (major comorbidities)
3rd gen cephalosporins (if allergic to penicillins)
Flouroquinolones (if intolerant to beta-lactams)
What group of bacteria are we concerned about for aspiration PNA?
Anaerobes!
What is the duration of therapy for HAP?
ATS recommends shorter course (7 days) for patients with uncomplicated HAP/VAP - inconclusive about longer durations of therapy
What pathogens do we cover for CAP?
Streptococcus pneumonia
Haemophilus Influenzae
Mycoplasma penumonia
Staphylococcus aureus
Chlamydia pneumonia
Legionella pneumophila
Moraxella catarrhalis
What is CURB-65?
5 parameters that estimate mortality of CAP to help determine inpatient v outpatient treatment
What are options for inpatient treatment of CAP?
Beta lactam + Macrolide
Flouroquinolone
Zosyn, cefepime or other anti-psuedomonal if concerned for pseudomonas
Vancomycin (if concerned for MRSA)
What are antimicrobial options for patients with aspiration PNA?
Unasyn (ampicillin/sulbactam)
Flagyl (metronidazole) + amoxicillin
Clindamycin (penicillin allergy)
Indicates that a patient has a bacterial infection
What pathogens should we cover for HAP?
MRSA/MSSA
Pseudomonas
What is the pneumonia severity index?
PSI estimates mortality in patients with CAP using 20 items
Which flouroquinolones have good lung penetration
Levofloxacin, Moxifloxacin
What are risk factors for MRSA?
Recent use of abc (w/in 90 days)
Prolonged hospitalization
MRSA colonization
Invasive procedures/open wounds
HIV
Nursing homes
How do we use pro-calcitonin in an inpatient setting?
De-escalation --> NOT initiation
What are risk factors for MDR pathogens?
Recent antibiotic use
ICU admission/Ventilation
Respiratory dx
Prolonged hospital stay
What are some differential diagnosis for patients with symptoms of CAP?
COVID-19, Flu, Viral infection, CHF, COPD, Bronchitis, Asthma exacerbation, Aspiration PNA, Drug reaction, Lung dx
What is first line treatment for HAP?
What are your treatment options for MRSA?
Vancomycin (1st line)
Linezolid (2nd line)
Doxycycline
Clindamycin
What is a DRIP score?
A tool used to guide empiric therapy for CAP in the hospital (based on major and minor risk factors)