Pulmonary Infections Review

Dr. Grock presents today’s Morning Report!

Pulmonary Infections

CAP

• If no abx in last 3 mo and healthy: A Macrolide (2^nd line Doxy)
• If chronic heart, lung, liver, renal disease, DM, ETOH, Ca, Asplenia, Immunosuppressed, or abx use in last 3 months: Resp fluoroquinolone, B-lactam + Macrolide
• If inpt: Resp Fluoroquinolone, B-lactam + Macrolide
• If ICU: B-lactam + azithro/resp fluoroquinolone. If Pen allergic: aztreonam/fluoro.
• If CA-MRSA concern: add vanco/linezolid
• If Pseudomonas concern: zosyn/cefepime/imipenem/meropenum + cipro/levo OR aminoglycoside and azithro OR aminoglycoside and antipneumococcal fluoro.
• Blood cultures?
• Admit? Curb-65, PSI, clinical judgement

HCAP

• (hosp for >2 days in last 90 days, NH, home infusion therapy, HD, home wound care)
• Cefepime/ceftazadime OR imipenem/meropenem OR zosyn AND cipro/levo OR gent AND vanco/linezolid
• Azithro?
• Admit All? (risk factors: Abx < 90 days, recent hosp >5 days, poor functional status, immunosuppressive dx and/or therapy. If > 2 “high risk”. If < 2 “low risk”. Low risk group = 50% of patients, 93% fine with CAP guidelines.)

PNA in AIDS

• AIDS: add Bactrim/azithro. ABG: PaO2<70, hypoxia on O2 sat, or A-a gradient >35 give steroids

Lung Abscess

• Clinda (2 studies show better than pens) with vanco/linezolid. Usually polymicrobial. Per Tintinalli’s add a cephalosporin/clinda. Flagyl sucks. Abx 80-90% effective.

References

• Lionel A. Mandell, et al. Infectious Diseases Society of America/American Thoracic Society Consensus Guidelines on the Management of Community-Acquired Pneumonia in Adults. IDSA/ATS Guidelines for CAP in Adults • CID 2007:44 (Suppl 2)
• Maruyama T, et al. A new strategy for healthcare-associated pneumonia: a 2-year prospective multicenter cohort study using risk factors for multidrug-resistant pathogens to select initial empiric therapy. Clin Infect Dis. 2013 Nov; 57(10):1373-83. doi: 10.1093/cid/cit571. Epub 2013 Sep 2.
• Emily Heil, PharmD, BCPS, AAHIVPThe Not-So-Sick Health-Care Associated Pneumonia Patient: New Treatment Strategy. ALiEM. November 26th, 2013 Retrieved from http://www.aliem.com/new-treatment-strategy-not-so-sick-health-care-associated-pneumonia/
• Uptodate.com
• Emedicine
• Tintinalli’s 7^th ed.

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• Bio
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Jay Khadpe MD

• Editor in Chief of "The Original Kings of County"
• Assistant Professor of Emergency Medicine
• Assistant Residency Director
• SUNY Downstate / Kings County Hospital

Latest posts by Jay Khadpe MD (see all)

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