Term
| Community acquired pneumonia (CAP |
|
Definition
Acute infection of the pulmonary parenchym
presence of an acute infiltrate consistent with pneumonia on chest radiography or ausculatory findings
must NOT have been hospitalized 2 days or more within the last 90 days, be a resident in a long-term care facility, have received IV antibiotic therapy, chemotherapy, or wound care in the past 30 days, or attendance at a hospital or hemodialysis clinic. |
|
|
Term
| Health care-associated pneumonia (HCAP |
|
Definition
pneumonia developing in a patient who was hospitalized in an
acute care hospital for 2 or more days within 90 days of the infection
who resided in a nursing home or long-term care facility
who received recent antibiotic therapy, chemotherapy, or wound care within the past 30 days of the current infection;
who attended a hospital or hemodialysis clinic |
|
|
Term
| Hospital-acquired pneumonia (HAP |
|
Definition
| pneumonia that occurs 48 hours or more after admission and is not incubating at the time of admission |
|
|
Term
| Ventilator-associated pneumonia (VAP): |
|
Definition
| pneumonia that arises more than 48 to 72 hours after endotracheal intubation |
|
|
Term
|
Definition
Invasion of organisms that colonize the lower respiratory tract by:
Inhalation of pathogens into lower respiratory tract
Aspiration of pathogenic organisms from the oropharynx
VAP most likely caused by microbes that have been dragged into the airways during the intubation procedure. |
|
|
Term
| Predictors of Complicated Course |
|
Definition
Age>65
Comorbid illness (diabetes mellitus, CHF, lung disease, renal failure, liver disease)
Temp>101F
Bacteremia
Altered mental status
Immunosuppression
High-risk etiology (S. aureus, Legionella, gram-negative bacilli, anaerobic aspiration)
Multilobe involvement |
|
|
Term
|
Definition
Confusion
Urea (BUN > 20 mg/dL)
Respiratory Rate (>30 breaths/min)
Blood Pressure (Systolic <90mm of Hg or diastolic <60 mm Hg)
AGE
Score: 0-1 (outpatient treatment)
2 (inpatient)
3-4 (ICU) |
|
|
Term
|
Definition
Serratia
Pseudomonus
Acineterbactor
Citerobacter
Enterobacter
G- bacilli that predict major problems |
|
|
Term
|
Definition
Alcoholism
Asthma
Immunosuppresion
Age>70 |
|
|
Term
|
Definition
Must have any two of the following:
Fever or hypothermia, rigors
Sweats,
New cough with or without sputum (90%)
Chest discomfort (50%)
Onset of dyspnea (66%)
Fatigue
Myalgias
Abdominal pain
Anorexia
Headache |
|
|
Term
|
Definition
Most common pathogen
Co-morbid conditions
Clinical trials demonstrating efficacy
Potential for inducing abx resistance
Cost |
|
|
Term
| CAP: Empiric treatment of non-hospitalized patients; In a previously healthy patients and no abx therpy in past 3 months |
|
Definition
Macrolide: Clarithromycin or if H. influenzae is suspected Azithromycin
Alternative doxycycline |
|
|
Term
| CAP: Empiric treatment of non-hospitalized patients;Comorbidities or high risk of Strep Pneumo resistance to macrolides (COPD, Diabetes, chronic renal or liver failure, CHF, malignancy, asplenia, or immunosuppression), or recent antibiotic therapy in past 3 months |
|
Definition
Respiratory fluoroquinolone (moxifloxacin, gemifloxacin or levofloxacin) [cover pneumo better)
Macrolide (or doxy) + high dose amoxicillin (1g TID) or augmentin (2g BID)
Macrolide (or doxy) + cephalosporin (ceftriaxone, cefuroxime, or cefpodoxime) |
|
|
Term
| Empiric CAP Tx for Hospitalized Patients |
|
Definition
Respiratory Quinolone (moxi, gemi or levofloxacin)
Macrolide (or doxycycline)Plus B-lactam: cefotaxime, ceftriaxone, ampicillin, ertapenem |
|
|
Term
| Empiric CAP Tx for ICU-Hospitalized Patients |
|
Definition
Respiratory Quinolone (moxi, gemi or levofloxacin) Plus B-lactam: cefotaxime, ceftriaxone, ampicillin-sulbactam
Azithromycin Plus B-lactam: cefotaxime, ceftriaxone, ampicillin-sulbactam |
|
|
Term
| Duration of Treatment (CAP) |
|
Definition
ISDA guidelines
Minimum of 5 days (LOE I)
Therapy should not be stopped until the patient is afebrile for 48-72 hours
Longer duration if complicated by extrapulmonary infection
Generally 7-10 days |
|
|
Term
| Risk Factors for Nosocomial Pneumonia |
|
Definition
Modifiable
Intubation and mechanical ventilation
Body position (supine)
Enteral nutrition
H2 antagonists
Immunosuppression
Non-Modifiable
Male
Elderly
Preexisting pulmonary disease
Multiple organ failure |
|
|
Term
| MRSA coverage: Glycopeptide |
|
Definition
Daptomycin- do not use in PNA
Vancomycin
Telavancin- Not FDA approved for PNA |
|
|
Term
| MRSA coverage: Cephlosporin |
|
Definition
| Ceftaroline-5th generation cephalosporin. FDA approval for CAP |
|
|
Term
|
Definition
Quinupristin-dalfopristin
Linezolid
Tigecycline
clindamycin |
|
|
Term
| Pseudomonal coverage: Cephalosporin |
|
Definition
|
|
Term
| Pseudomonal coverage: Carbapenem |
|
Definition
Imipenem
Meropenem
Doripenem |
|
|
Term
| Pseudomonal coverage: Penicillin |
|
Definition
Piperacillin-tazobactam
Ticarcillin-Clavulanate |
|
|
Term
| Pseudomonal coverage: Aminoglycosides |
|
Definition
Gentamicin
Tobramycin
Amikacin |
|
|
Term
| Pseudomonal coverage: Monobactam |
|
Definition
|
|
Term
| Therapy Selection of HAP, VAP and HCAP |
|
Definition
Risk factors for MDR pathogens
Resident flora in hospital
Presence of underlying diseases
Available culture data |
|
|
Term
| Risk Factors for MDR causing HAP, VAP and HCAP |
|
Definition
Antibiotic therapy within the past 90 days
Hospitalization of 5 days or more
High resistance in community or hospital unit
Risk factors for health care-associated PNA
Immunosuppressive disease and/or therapy |
|
|
Term
| HCAP, HAP and VAP early onset |
|
Definition
Less than 5 days
No risk factors for MDR organisms: S. pneumoniae, Haemophilus influenzae, methicillin-sensitive S aureus (MSSA), Escherichia coli, Klebsiella pneumoniae, Enterobacter spp., and Proteus spp.)
Therapy: ONE of the following
Third generation cephalosporin
Cefotaxime
Ceftriaxone
Fluoroquinolone
Levofloxacin, moxifloxacin, ciprofloxacin
Ampicillin/sulbactam
Ertapenem |
|
|
Term
| HCAP, HAP, and VAP late onset or risk for MDR organisms |
|
Definition
Ceftazidime or cefepime + aminoglycoside or fluroquinolone
Imipenem, meropenem or doripenem + aminoglycoside or fluroquinolone
Piperacillin/tazobactam + aminoglycoside or fluroquinolone
+ Vancomycin or Linezolid if MRSA risk factors |
|
|
Term
| Duration of treatment (HCAP, HAP, and VAP) |
|
Definition
7 to 8 days good clinical response
14 days if pneumonia due to Pseudomonas aeruginosa
21 days if MRSA |
|
|
Term
|
Definition
Influenza vaccine for all persons ≥ 50, household contacts of high risk persons, health care workers
Pneumococcal polysaccharide vaccine for persons ≥ 65 and those with high risk concurrent diseases.
Smoking cessation
Respiratory hygiene: hand hygene, masks to reduce spread |
|
|
Term
|
Definition
Make recommendations based on CAP, HAP, VAP, and HCAP
Drug deescalation based on cultures
Reminder to dc antibiotic
Switch from IV to PO
Vaccination |
|
|
