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30 Cards in this Set
- Front
- Back
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3 types of lower respiratory tract infections
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pneumonia
acute exacerbations of chronic bronchitis acute bacterial exacerbations of chronic bronchitis |
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3 routes of lower respiratory tract infections
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inhalation
aspiration hematogenous spread |
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3 main organisms causing lower respiratory tract infections
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S. pneumoniae
H. influenzae M. catarrhalis |
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3 atypical organisms causing lower respiratory tract infections
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M. pneumoniae
C. pneumoniae Legionella pneumophia |
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2 rare organisms causing lower respiratory tract infections
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S. aureus
influenza |
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demographic concerns in lower respiratory tract infections
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-age
-comorbidities -social Hx (travel, close contacts, smoking, EtOH) -pathogen exposure |
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clinical presentation of lower respiratory tract infections
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-cough
-dyspnea -sputum production -pleuritic chest pain -fever |
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physical findings of lower respiratory tract infections
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tachypnea
tachycardia inspiratory crackles diminished breath sounds inc. WBC, poss left shift |
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purpose of chest x-ray in lower respiratory tract infections
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essential for accurate diagnosis
-rules out other causes of respiratory failure (CHF) -typical presentation: dense lobar or segmental infiltrates -rarely negative in the presence of pneumonia |
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sputum evaluation
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gram stain
-rules out rare organisms culture -Dx of pathogen -absence of S. aureus or G- bacilli excludes these organisms |
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mucopurulent sputum indicates
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bacterial infxn
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scant/watery sputum indicates
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atypical or viral infxn
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"rusty" sputum indicates
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pneumococcal
staphylococcal |
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dark red, mucoid sputum indicates
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K. pneumoniae
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fould-smelling sputum indicates
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anaerobic
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other diagnostic tests in lower respiratory tract infection
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blood cultures
urinary antigen sputum staining low-titer cold agglutinin |
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describe atypical pneumonia
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-usual S/Sx not always present
-older patients, comorbidities, travel Hx -pathogens --M. or C. pneumoniae --Legionella pneumophila |
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describe aspiration pneumonia
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-5-10% nosocomial pneumonia
-also occurs in outpatients, but rarely -risk factors ----altered consciousness due to EtOH or drug OD or seizures ----gingival disease pathogens -oral flora -GI flora -anaerobes |
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risk stratification by age
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>60-65 years
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severe determinants
(hospitalize these people) |
neoplasm
hepatic disease CHF CVD renal disease |
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pathogen determinants
(determine differential diagnosis) |
alcoholism
smoking/COPD poor dentition |
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who should be hospitalized?
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-risk of death or complications
-presence of metastatic disease (pneumonia, not CA) -presence of comorbidities -infection by high-risk pathogen -compliance -Pneumonia Severity Index (PSI) score |
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treatment principles for CAP
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determine severity of infection
----outpt v. inpatient consider comorbidities determine likely pathogen ---cover common typical and atypical pathogens ---monotherapy |
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CAP Tx - outpatient
no comorbidities no use of Abx in prev 3 months |
macrolide (any)
doxycycline |
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CAP Tx - outpatient
comorbidities OR use of Abx in prev 3 months |
respiratory FQ (L, M, or G)
OR macrolide + BL: -high-dose amoxicillin -high-dose augmentin -ceftriaxone |
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CAP Tx - inpatient
not admitted to ICU |
respiratory FQ (L, M, or G)
OR macrolide + BL: -high-dose amoxicillin -high-dose augmentin -ceftriaxone |
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CAP Tx - inpatient
admitted to ICU |
BL
-ceftriaxone -Unasyn AND azithromycin or resp FQ |
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RF for HAP
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-prior Abx use
-intubation -advanced age, comorbidities -H2RA use (aspiration, inc pH allows more GI flora to survive) -sedation (aspiration) |
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HAP Tx
No late onset No risk for MDR pathogens |
limited spectrum therapy
ceftriaxone FQ (L,M) ertapenem |
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HAP Tx
late onset OR risk for MDR pathogens |
broad spectrum therapy
1) cefepime/ceftazidime imipenem, meropenem, doripenem piperacillin, piperacillin/tazobactam AND 2) cipro/levo OR aminoglycoside |
