5 kinds of possible pneumonia
1. CAP
2. Aspiration
3. Hospital Acquired
4. Ventilator Acquired
5. Health Care Acquired
2. Aspiration
3. Hospital Acquired
4. Ventilator Acquired
5. Health Care Acquired
What is CAP?
Pneumonia acquired outside an healthcare facility
What is Aspiration Pneumonia?
Aspiration of oral or GI content
Common Pathogens of Aspiration Pneumonia?
Anerobes; Strep Viridians; gram – (neg) bacilli
What Hospital Acquired Pneumonia?
pneumonia that occurs greater than 48 hours of admission
What is ventilator associated Pneumonia?
Pneumonia after 48 to 72 hours of intubation?
What is Healthcare associated pneumonia?
-Hospitalized 2 days within 90 days
-SNF or LTC
-Iv abx, wound care, chemo, HD within last 30days
-resembles HAP, but MORE RESISTANT bacteria
-SNF or LTC
-Iv abx, wound care, chemo, HD within last 30days
-resembles HAP, but MORE RESISTANT bacteria
3 ways to assess Pna severity
1- PSI= Pna severity index
2- CURB-65
3- SOAR score
2- CURB-65
3- SOAR score
Describe PSI
-yes/no
-looks at age >50
-Vital
RR >30
SBP <90 P>125/min
Temp= 95 or lower OR 104 or higher
-Confusion
-Prior Hx
-looks at age >50
-Vital
RR >30
SBP <90 P>125/min
Temp= 95 or lower OR 104 or higher
-Confusion
-Prior Hx
If any Yes go to next questionaire
If NO to all, Rsk class 1
PSI RSK categories
Risk II: 70 or less
Risk III: 71 to 90
Risk IV: 91- 130
Risk V: Greater than 130
Risk III: 71 to 90
Risk IV: 91- 130
Risk V: Greater than 130
What does Risk class II or III mean?
Low risk and outpt
What does Risk class IV or V mean?
Moderate Risk IV (9%increase)
High Risk for V (27%incrase)
Hospitalize and increase mortality
High Risk for V (27%incrase)
Hospitalize and increase mortality
CURB 65 stand for?
-based on 1 point system
Confusion
Uremia BUN >19
Resp. Rate >30/min
BP systolic < 90 age >65
Confusion
Uremia BUN >19
Resp. Rate >30/min
BP systolic < 90 age >65
Point System of CURB
1= outpt
2 or greater= hospitalize
2 or greater= hospitalize
SOAR score
-based on 1 point system
S= Systolic BP <: FiO2 < 125 Age >65
RR >30
S= Systolic BP <: FiO2 < 125 Age >65
RR >30
Why CURB 65 over SOAR?
SOAR is more senstive and considered O2 factor, but CURB 65 is more specific
Acronym for TX of CAP Normal outpt
May Do prior abx FQ PAC
-Macrolide
-Doxy
IF prior abx use
-Azithro/Clarithro + HD aug/amoxicillin
-Macrolide
-Doxy
IF prior abx use
-Azithro/Clarithro + HD aug/amoxicillin
Acronym for TX CAP Abnormal normal outpt
GLaM PAC 23
Gemi, Levo, Moxi
Azithro/Clarith+ HD aug/Amox
Azithro/Claritho + Podi, Dinir, Pro
Gemi, Levo, Moxi
Azithro/Clarith+ HD aug/Amox
Azithro/Claritho + Podi, Dinir, Pro
Acronym for TX Hosp. CAP
Tri LAM Erta
Levo/Moxi
Azithro + cefTRI
Azithro + Erta
Levo/Moxi
Azithro + cefTRI
Azithro + Erta
Acronym for NO pseudomonas concern
3 + Animals Must Leave
-CefTAX or CefTAZ + azithro
-Moxi/ Levo
-CefTAX or CefTAZ + azithro
-Moxi/ Levo
Pseudomonas Concern for PNA
34 Zebras In Mor CAL
-CefTAZ, CefPIME
-Zosyn
-Imi
-Mero + cipro
-Mero + AG
-Mero + Levo
-CefTAZ, CefPIME
-Zosyn
-Imi
-Mero + cipro
-Mero + AG
-Mero + Levo
MRSA for Pseudomonas concern
ADD vanco to previous
or
ADD Linezolid to previous
or
ADD Linezolid to previous
acronym for NO MDR for HAP/VAP/HCAP
3 Elephants Like GUM
-TRI/TAX
-Erta
-Levo/MOxi/Gemi
-Unasyn
-TRI/TAX
-Erta
-Levo/MOxi/Gemi
-Unasyn
Acronym for MDR concern for HAP/VAP/HCAP
LIZ’s 34 Mero CATs
-Levo
-Imi/Mero
-zosyn/Timetin
-TAZ/PIME
-Cipro
-AG
-Levo
-Imi/Mero
-zosyn/Timetin
-TAZ/PIME
-Cipro
-AG
MSRA for HAP/VAP/HCAP
ONLY vanco
or
Linezolid
or
Linezolid
Duration of Therapy for Adult Outpt on Levo/Azithro
5 days
all other agents = 7-10 days
all other agents = 7-10 days
Duration of uncomplicated CAP for pediatrics
10 days, except Azithro or Levo= 5 days
Duration for negative chest x-ray
7 days
Duration for positive chest x-ray
14 days
HCP/ VAP
10-24 days
-if no pseudomonas 7 days