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
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