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CC May 2016 Healthcare-associated Pneumonia (HCAP)

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echoecho's version from 2016-07-29 03:11

Section

Question Answer
Aspiration is a common event in health adults and resolves w/o sequelae, why?the amount of inoculum is usually small and most individuals are able to clear the aspirated organism
What develops when the organisms can't be cleared?pneumonia
Pulmonary complications usually depends on what?1) volume 2) contents 3) bacterial inoculums (virulence and size) 4) host defense mechanisms
Aspiration is more problematic and common in what type of patient? Why?1) elderly with dementia 2) these patients are morelikely to have dysphagia (allowing for recurrent inoculation of the respiratory tract and reduced ability to clear the infection)
Define aspiration pneumonia?an infection caused by anaerobi bacteria, which are common components of the host's normal oropharyngeal and gastric flora
Any pt with an observed aspiration should receive what?immediate tracheal suction to clear any obstruction
Will tracheal suction prevent chemical injury? Will it retrieve any particulate matter that has already been aspirated?1) no 2) no
Define CAP (community-acquired penumonia)?when an otherwise healthy community dweller develops pneumonia
List the most common associated bacterial organisms causing CAP?1) S. pneumoniae 2) H. influenza 3) M. penumonia 4) legionella pneumophilia
Assuming no recent abx therapy and low resistance, outpt rx would be?1) azithromycin (Zithromax) 2) clarithromycin (Biaxin) 3) doxycycline (Doryx)
Define HCAP (health care associated pneumonia)?pneumonia in a nonhospitalized individual who has had extensive healthcare contact defined as 1)residence in a nursing home or other long-term care facility 2) hospitalization w/in the past 90 days (stay of at least 2 days) 3) attendance at a hemodialysis clinic or hospital w/in the past 30 days 4) rx with IV chemotherapy, IV therapy or wound care in the past 30 days
Define SIRS (systemic inflammatory response syndrome)?1) temp > 100.9 2) tachypnea 3) tachycardia 4) leukocytosis > 12,000 - indicating severe infection
*** Because of these factors it is necessary to do what with the patient with SIRS?1) hospitalize patient 2) cover him initially for anaerboes, atypical agents (especially Legionella) and MRSA
What would be the appropriate empiric antibiotic regimen for the above patient?1) piperacillin / tazobactam PLUS levofloxacin (coverage of usualy (CAP) pneumonia agents, plus dual antispseudomonal coveral and anaerobic coverage 2) Levofloxacin for Legionella 3) Vancomycin for MRSA
*** Daily reassessment and following blood and sputum cultures is necessary, why?to determine whether the pt is a candidate for de-esculation in therapy, in order to PREVENT the development of resistance, reduce toxicity and reduce costs
*** SUMMARY = Define HCAP (health care associated pneumonia)?pneumonia in a nonhospitalized individual who has had extensive healthcare contact (nursing home residence, hospitalization in the last 90 days)
*** SUMMARY = Initial antibiotic coverage for HCAP must be broader than for CAP, why?because anaerobes, atypical agents (especially Legionella)and MRSA may be etiologic agents
*** SUMMARY = De-escalation of antibiotic therapy should occur once what is identified?etiologic agent
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