Download - Bacterial Pneumonia

Bacterial Pneumonia

Sung Chul Hwang, M.D.

Dept. of Pulmonary and Critical Care Medicine

Ajou University School of Medicine

Epidemiology

• 6th leading cause of death in U.S.• Number one Among the infectious disea

ses• 4 million patients annually in US• Incidence 12/1,000/year• Mortality in OPD patients 1-5 %, but Inp

atients 25%, ICU 50-60%

Definition

• Pneumonia is the inflammation of lower respiratory tracts including alveoli, interstitial tissues, and broncioles by the microorganisms, chemical irritations or by an immunological process

Classifications & Terminology

• Community Acquired Pneumonia Nosocomial Pneumonia Ventilator Associated Pneumionia• Mild, moderate, severe • Bacterial, viral, fungal, parasitic• Primary vs. Secondary• Immune compromised vs. Normal immunity• Lobar vs interstitial• Typical vs. Atypical

Severe Community Acquired Pneumonia

• Respiratory rate > 30/min• PaO2/FiO2 ratio < 250mmHg• Need for Mechanical Ventilation• Diffuse bilateral involvement or multiple lobes,

incresing infiltration > 50% within 48 hours• B.P. < 90systolic or 60 mmHg diastolic• Need for vasopressors• Renal failure

Mycoplasma Pneumonia

Streptococcal Pneumonia

Streptococcus pneumoniae

Gram + Diplococci

Streptococcal Pneumonia

Staphylococcus aureus

BAL Fluid

Staphylococcal Pneumonia

Pneumatocele


Osler’s Node

Pseudomonas Pneumonia

Pseudomonas Pneumonia

Ecthyma gangrenosum

Immunofluorescent Ab Test

RSV Antigen Detection

Legionella Pneumonia

Legionella Pneumonia

Legionella pneumophila by Silver impregnation Stain

Pneumonia in COPD

CMV Inclusion in BAL

Sputum Gram Stain

Treatment of CAP <60yrs/OPD/no Comorbid conditions

• Pathogens : S. pneumoniae, Mycoplasma& Chlamydia pne

umoniae, H. indfluenzae, RSV, Legionella, S. aureus

• Treatment : 2nd Generation Cephalosporin + Macrolide or Q

uinolone monotherapy

Treatment of CAP >60yrs/OPD/with Comorbid conditions

• Pathogens : S. pneumoniae, RSV, H. indfluenzae, Gram (-)

rod, S. aureus, Morexella catarrhalis, Legionella spp.

• Treatment : 2nd Generation Cephalosporin + TMX/SFX, or

beta lactam/betalactam inhibitor + Macrolide

Treatment of Severe CAP

• Pathogens : S. pneumoniae, Legionella spp. Gram (-)

rod, Mycoplasma,H. indfluenzae,S. aureus • Treatment : 3rd Generation Cephalosporin with anti-Pseud

omonal activity or + other anti Pseudomonal agent (Imipenem/quinolone) + Macrolide

Aspiration Pneumonia

Lipoid Pneumonia