Pneumonia
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Transcript of Pneumonia
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Pneumonia
Steven Podnos MD
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Etiology
• Aspiration primary cause for bacterial pneumonia
• Aerosol transmission important for viral/atypical/TB
• Abnormal host response may be important in immuncompromised patients-neutropenia, PCP
• Important to know oral flora
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Risk Factors
• Community Acquired “Healthy”• Community Acquired “Sick”• Health Care Associated
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Clinical Features
• History• PE-RR,Fever, Hypoxemia, Hypercapnia, Shock,
Chest Pain• Sputum• CXR• WBC, Na• ABG
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Community Acquired Pneumonia
• Etiology-Viral/Atypical/Bacteria-Pneumococcus, H. Flu
• Clinical Presentation guides both decision to admit and initial Rx
• Discuss Diagnostic Approach
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Criteria for clinical stability.
Mandell L A et al. Clin Infect Dis. 2007;44:S27-S72
© 2007 by the Infectious Diseases Society of America
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Clinical indications for more extensive diagnostic testing.
Mandell L A et al. Clin Infect Dis. 2007;44:S27-S72
© 2007 by the Infectious Diseases Society of America
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Therapy
• Timing of first dose important• Length of Rx variable• Oral vs. IV considerations
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Recommended empirical antibiotics for community-acquired pneumonia.
Mandell L A et al. Clin Infect Dis. 2007;44:S27-S72
© 2007 by the Infectious Diseases Society of America
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Health Care Associated Pneumonia
• Increased risk of aspiration if intubated• Ventilator Care Bundles• Other attempts to prevent• Etiology, MDR, Gram neg, Staph and MRSA but
can also have CAP type organisms
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Potential Pathogens Combination Antibiotic Therapy*
Pathogens listed in Table 3 and
MDR pathogensAntipseudomonal cephalosporin
(cefepime, ceftazidime)
Pseudomonas aeruginosa or
Klebsiella pneumoniae (ESBL+) Antipseudomonal carbepenem
Acinetobacter species (imipenem or meropenem)
or
ß-Lactam/ß-lactamase inhibitor(piperacillin–tazobactam)
plus
Antipseudomonal fluoroquinolone
(ciprofloxacin or levofloxacin)
or
Aminoglycoside
(amikacin, gentamicin, or tobramycin)
plus
Methicillin-resistant Staphylococcus
aureus (MRSA) Linezolid or vancomycin
Legionella pneumophila
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Non Antibiotic Rx
• Oxygen• ARDS net ventilation vs BiPAP• IVF• Resp RX
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Non responders