Therapeutics - LRTI 1
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What are the complications of Pneumonia?
- Pleural fibrosis
- Empyema (infection of the pleural sac)
- Bronchiectasis (enlarged bronchioles)
What are the frequent comorbidities associated with pneumonia?
What does HAP mean?
Symptoms present a minimum of 48 hours after admission
What constitutes HCAP?
Hospitalized for 2 days in the past 90 days, attends hemodialysis, resides in a nursing home or has had chemotherapy in the last 30 days
What constitutes VAP?
Symptoms develop w/in 48-72 hours after endotracheal intubation
What are the risk factors for CAP?
- Young adult
- Close proximity
What are the common organisms that cause CAP (in order of occurance)?
- Streptococcus pneumonia.
- Mycoplasma pneumonia.
- Haemophilus influenzae
- Legionella pneumophilia
- Klebsiella pneumonia
What are the common organisms that cause, HCAP, HAP and VAP (in order of occurance)?
- Streptococcus pneumoniae
- Legionella pneumo.
- Klebsiella pneumon.
- Pseudomonas aerugen.
- E. Coli
- Staph. aureus
- Staph. aureus (MRSA)
What are the risk factors for HCAP, HAP and VAP?
- Mechainical ventilation
- Acid suppressive therapy
What is the most likely organism to cause Cap in young adults?
What is the most common organism to cause CAP in alcoholics?
To prevent CAP, all splenectomy patients should receive what prophylactic treatment?
What are the S/S specific to atypical peneumonia?
- Low-grade fever or afebrile
- Dry, persistent cough
What are the S/S that indicate Typical pneumonia?
- Cough with sputum production
- Pleuritic chest pain
What physical findings are associated with pneumonia?
- Distant breath sounds (Because puss filled ducts do not conduct the sound as well)
- Inspiratory crackles
- Dullness to percussion
- Tachypnea (Causes dry lips and exhaustion)
- Tachycardia (compensate for low O2 in blood)
What sputum culture results indicate a pathogen?
< 10 epithelial cells and many PMNs
What is the main biomarker of bacterial infection in pneumonia?
What are normal concentrations of Procalcitonin?
What Procalcitonin value indicates bacterial infection and should receive antibiotics?
> Or = to 0.25 ng/mL
How often should pro-calcitonin levels be measured?
When using procalcitonin levels to guide antibiotic therapy, when should you discontinue antibiotics?
When PCT levels fall below 0.25 ng/mL or by 80% of the max concentration
What are the general supportive treatments for Pneumonia that should be given to all patietns?
What is evaluated in a CURB 65 score?
- Age> or = to 65
What is included in the CRB65 score?
- Age> or = to 65
What CURB 65 score indicates low risk and at home treatment?
What CURB 65 score indicates short inpatient hospitalization or closely supervised as an outpatient?
What would you like to do?
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