KNOWING PNEUMONIA

JUAN I. IRIZARRY NIEVES

HOSPITAL SAN CRISTOBAL
 IMPORTANCE
• CAP ACCOUNTS FOR 4.5
MILLION OUTPATIENT AND ER
ROOM VISITS
• SECOND MOST COMMON
CAUSE OF HOSPITALIZATION
• MOST COMMON CAUSE OF
INFECTIOUS DEATH
• 650 PER 100,000 = 1.5 MILLION
ADULTS ARE HOSPITALIZED
WITH CAP EACH YEAR (US)
PATHOPHYSIOLOGY
 TYPES OF PNEUMONIA
Type Description Organism
Community Acquired Acquired outside of hospital or S. pneumo, H. influenzae, M. catarrhalis
healthcare facility
Nosocomial >48 hours after hospital admission Pseudomona, MRSA, MSSA, Acinetobacter

Ventilator Associated >48 hours after endotracheal S. Aureus, Pseudomona, Klebsiella,

intubation Enterobacter

Atypical Not present in gram stain RSV, parainfluenza, CMV, VZV, SARS,
Mycoplasma, Chlamydophila, Legionella
Aspiration Inhalation of oropharyngeal Bacteroides, Porphyromonas,
contents Fusebacterium, anaerobic GP cocci
Fungal Umm… fungal Coccidiomycosis, aspergillosis,
Pneumocystis
 RISK FACTORS

• OLD AGE
• CHRONIC COMORBIDITIES
• VIRAL RASPATORY TRACT INFECTION
• IMPAIRED AIRWAY PROTECTION
• SMOKING AND ALCOHOL OVERUSE
• LIVING CONDITIONS
FINDINGS
FINDINGS
DIAGNOSTIC TESTS
• IMAGING: CXR (PA AND LAT.), CHEST CT
• IMMUNOCOMPROMISED PATIENTS MAY HAVE NEGATIVE
CXR DUE TO LOW INFLAMMATORY RESPONSE
• LABS: CBC, BMP, ABGS, ESR/CRP, PROCALCITONIN
• CULTURES: BLOOD, SPUTUM, PLEURAL FLUID
• SPECIAL TEST: PCR, URINARY ANTIGEN, COLD
AGGLUTIN, TB
TO HOSPITALIZE, OR NOT? THAT IS
THE QUESTION.
TREATMENT
• OUTPATIENT (FIRST TIME) → MACROLIDE OR TETRACYCLINE
• AZITHROMYCIN 500MG PO D THEN 250MG PO FOR 4 D
• DOXYCYCLIN 100MG PO D
• OUTPATIENT (COMORBIDITIES OR RESISTANT) → FQ’S OR
COMBO
• LEVOFLOXACIN 750MG PO D
• AUGMENTIN 2000MG PO AND CLARITHROMYCIN 500MG Q12HR
 TREATMENT INPATIENT
ICU Pseudomonal Preferred treatment

No No Azithromycin 500mg and ampicillin 1g D

No Yes Zosyn 4.5g IV q 6hr and levofloxacin 750mg IV D
Yes No Ampicillin/sulbactam 1.5-3g IV q 6hr and levofloxacin 750mg
IV D
Yes Yes Zosyn 4.5g IV q 6hr and levofloxacin 750mg IV D

• ADJUVANT FOR MRSA → VANCOMYCIN 15MG/KG IV Q 12HR OR

LINEZOLID 600MG IV Q 12HR
• CORTICOSTEROIDS (METHYLPREDNISOLONE) →
RECOMMENDED IN SOME PATIENTS WITH SEVERE CASES IN ICU
COMPLICATIONS
KEEP CALM AND BREATH ON!