Pneumonia Definitions and Acronyms

5 kinds of possible pneumonia
1. CAP
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

3 ways to assess Pna severity
1- PSI= Pna severity index
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

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

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

CURB 65 stand for?
-based on 1 point system
Confusion
Uremia BUN >19
Resp. Rate >30/min
BP systolic < 90 age >65

Point System of CURB
1= outpt
2 or greater= hospitalize

SOAR score
-based on 1 point system
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

Acronym for TX CAP Abnormal normal outpt
GLaM PAC 23
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

Acronym for NO pseudomonas concern
3 + Animals Must Leave
-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

MRSA for Pseudomonas concern
ADD vanco 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

Acronym for MDR concern for HAP/VAP/HCAP
LIZ’s 34 Mero CATs
-Levo
-Imi/Mero
-zosyn/Timetin
-TAZ/PIME
-Cipro
-AG

MSRA for HAP/VAP/HCAP
ONLY vanco
or
Linezolid

Duration of Therapy for Adult Outpt on Levo/Azithro
5 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

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