Pneumonia

Steven Podnos MD

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

Risk Factors

• Community Acquired “Healthy”• Community Acquired “Sick”• Health Care Associated

Clinical Features

• History• PE-RR,Fever, Hypoxemia, Hypercapnia, Shock,

Chest Pain• Sputum• CXR• WBC, Na• ABG

Community Acquired Pneumonia

• Etiology-Viral/Atypical/Bacteria-Pneumococcus, H. Flu

• Clinical Presentation guides both decision to admit and initial Rx

• Discuss Diagnostic Approach

Criteria for clinical stability.

Mandell L A et al. Clin Infect Dis. 2007;44:S27-S72

© 2007 by the Infectious Diseases Society of America

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

Therapy

• Timing of first dose important• Length of Rx variable• Oral vs. IV considerations

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

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

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

Non Antibiotic Rx

• Oxygen• ARDS net ventilation vs BiPAP• IVF• Resp RX

Non responders