Misc
What is the most common cause of bacterial PNA
Strep Pneumonia
In a patient with a viral pneumonia, which test can help determine if bacterial coinfection is present
Procalcitonin
At what age is it recommended for all adults to get Pneumonia Vaccination
At 65 or older
Preferred antimicrobial regimen for patients admitted to the hospital for PNA without risk factors for MRSA or Pseudomonas
β-lactam + macrolide (preferred)
What test can help us discontinue MRSA Abx Coverage
MRSA nasal swab: • If negative, discontinue MRSA coverage (>95% negative predictive value in CAP) • If positive, may not be indicative of MRSA pneumonia
What time period do you start antivirals for influenza virus in patients admitted to the hospital
As soon as possible
Per the CDC what is the only contraindication to getting a flu vaccine (not live attenuated)
Severe Allergic Reaction (Anaphylaxis)
For healthy outpatient adults without comorbidities or risk factors for antibiotic resistant name a recommended treatment abx/regiment
amoxicillin 1 g three times daily (strong recommendation, moderate quality of evidence)
doxycycline 100 mg twice daily (conditional recommendation, low quality of evidence)
a macrolide (azithromycin 500 mg on first day then 250 mg daily or clarithromycin 500 mg twice daily or clarithromycin extended release 1,000 mg daily) only in areas with pneumococcal resistance to macrolides <25%
IDSA preferred scoring system to help determine if a patient with Pneumonia needs hospitalized
Pneumonia Severity Index
What is the indication to give decadron in COVID-19 infection
Severe disease, O2 sats < 94%
What Precautions need be taken for patient with hx of Egg Allergy receiving flu vaccine
None
All persons ages ≥6 months with egg allergy should receive influenza vaccine. Any influenza vaccine (egg based or non-egg based) that is otherwise appropriate for the recipient’s age and health status can be used.
Egg allergy necessitates no additional safety measures for influenza vaccination beyond those recommended for any recipient of any vaccine, regardless of severity of previous reaction to egg.
Severe and life-threatening reactions to vaccines can occur with any vaccine and in any vaccine recipient, regardless of allergy history. All vaccines should be administered in settings in which personnel and equipment needed for rapid recognition and treatment of acute hypersensitivity reactions are available.
For outpatient adults with comorbidities such as chronic heart, lung, liver, or renal disease; diabetes mellitus; alcoholism; malignancy name a treatment abx/regimen
Combination therapy:
amoxicillin/clavulanate 500 mg/125 mg three times daily, or amoxicillin/clavulanate 875 mg/125 mg twice daily, or 2,000 mg/125 mg twice daily, or a cephalosporin (cefpodoxime 200 mg twice daily or cefuroxime 500 mg twice daily); AND
macrolide (azithromycin 500 mg on first day then 250 mg daily, clarithromycin [500 mg twice daily or extended release 1,000 mg once daily]) (strong recommendation, moderate quality of evidence for combination therapy), or doxycycline 100 mg twice daily (conditional recommendation, low quality of evidence for combination therapy); OR
Monotherapy:
respiratory fluoroquinolone (levofloxacin 750 mg daily, moxifloxacin 400 mg daily, or gemifloxacin 320 mg daily) (strong recommendation, moderate quality of evidence).
Trial which showed steroids in Severe Community-Acquired Pneumonia reduced 28-day mortality by almost 50%
CAPE COD Trial
What 2 things do you need to diagnosis of Community-acquired Pneumonia in Adults (≥ 18 years) Without Immunocompromising Conditions in hospitalized patients
Newly recognized pulmonary infiltrate(s) on chest imaging† AND at least one respiratory symptom AND at least one other symptom/sign or finding (see below)
Respiratory Symptoms (at least one)
New or increased cough
New or increased sputum production
Dyspnea
Pleuritic chest pain
Other Signs or Findings (at least one)
Abnormal lung sounds (rhonchi or rales)
Fever (≥100.4 °F)
Leukocytosis or unexplained bandemia (above normal limits for laboratory)
Hypoxia (< 90%)
What is the clinical definition of Severe Covid-19 infection (not radiological)
O2 saturation less than 94% on room air
Which PNA Vaccine is Recommended
The United States Centers for Disease Control (CDC) and Prevention Advisory Committee of Immunization Practices (ACIP) recommends administration of PCV20 alone or PCV15 in series with PPSV23 for all patients with an indication for pneumococcal vaccination
For Most Patients hospitalized with Aspiration Pneumonia what is the treatment regiment
Same as CAP. Unless Lung Empyema/Abscess suspected
Aside from hx of colonization or infection with MRSA or Pseudomonas, what is a risk factor for having these organisms
IV abx in the past 90 days
What are the 3 antiviral drugs used in mild to moderate covid-19 infection to prevent progression to severe disease
Remdesivir, Molnupirivir, Nirmeltavir/Ritonavir
Indication for RSV Vaccination
The CDC recommends a single dose of the RSV vaccine for adults 60 years and older, especially those with chronic medical conditions or other risk factors. These risk factors include:
For Patients Clinicall Improving what is the total duration needed for treatment of PNA
Consider duration of antibiotics administered (no more than 3-5 days total in the ED and inpatient)