Community acquired pneumonia resident survival guide: Difference between revisions

Jump to navigation Jump to search
← Older editNewer edit →
VisualWikitext
Chetan Lokhande (talk | contribs)
nocaptcha
4,484 edits
Chetan Lokhande (talk | contribs)
nocaptcha
4,484 edits
Line 79: Line 79:


==Do's==
==Do's==
*Provide coverage for [[Streptococcus pneumoniae]] and atypical bacteria like ([[Mycoplasma]], [[Chlamydophila]], [[Legionella]] ).<ref name="www.nejm.org">{{Cite web  | last =  | first =  | title = MMS: Error | url = http://www.nejm.org/doi/pdf/10.1056/NEJMcp1214869 | publisher =  | date =  | accessdate = }}</ref>
*Perform aggressive fluid resuscitation, prompt antibiotic initiation, measure arterial blood gas in patients who have borderline [[hypoxemia]] or [[lactate]].<ref name="Rivers-2001">{{Cite journal  | last1 = Rivers | first1 = E. | last2 = Nguyen | first2 = B. | last3 = Havstad | first3 = S. | last4 = Ressler | first4 = J. | last5 = Muzzin | first5 = A. | last6 = Knoblich | first6 = B. | last7 = Peterson | first7 = E. | last8 = Tomlanovich | first8 = M. | title = Early goal-directed therapy in the treatment of severe sepsis and septic shock. | journal = N Engl J Med | volume = 345 | issue = 19 | pages = 1368-77 | month = Nov | year = 2001 | doi = 10.1056/NEJMoa010307 | PMID = 11794169 }}</ref>
*Treat co-existing illness like [[asthma]] and [[COPD]] with [[bronchodilators]].
*Start empirical therapy with coverage for [[Pseudomonas aeruginosa]] and [[MRSA]] if patient is hospitalized for more than 2 days.<ref name="-2005">{{Cite journal  | title = Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. | journal = Am J Respir Crit Care Med | volume = 171 | issue = 4 | pages = 388-416 | month = Feb | year = 2005 | doi = 10.1164/rccm.200405-644ST | PMID = 15699079 }}</ref>
*Give high priority to patients with elevated [[blood urea nitrogen]] (BUN), confusion and high respiratory rate.<ref name="Lim-2013">{{Cite journal  | last1 = Lim | first1 = HF. | last2 = Phua | first2 = J. | last3 = Mukhopadhyay | first3 = A. | last4 = Ngerng | first4 = WJ. | last5 = Chew | first5 = MY. | last6 = Sim | first6 = TB. | last7 = Kuan | first7 = WS. | last8 = Mahadevan | first8 = M. | last9 = Lim | first9 = TK. | title = IDSA/ATS minor criteria aided pre-ICU resuscitation in severe community-acquired pneumonia | journal = Eur Respir J | volume =  | issue =  | pages =  | month = Oct | year = 2013 | doi = 10.1183/09031936.00081713 | PMID = 24176994 }}</ref>:
*First antibiotic dose should be administered within 6 hours of admission into the emergency room.<ref name="Wilson-2011">{{Cite journal  | last1 = Wilson | first1 = KC. | last2 = Schünemann | first2 = HJ. | title = An appraisal of the evidence underlying performance measures for community-acquired pneumonia. | journal = Am J Respir Crit Care Med | volume = 183 | issue = 11 | pages = 1454-62 | month = Jun | year = 2011 | doi = 10.1164/rccm.201009-1451PP | PMID = 21239689 }}</ref>
* [[Shock]] is an exception where antibiotic should be started within an hour of [[hypotension]]. A decrease in 8% of survival rate for each hour of delay is noted.<ref name="Kumar-2006">{{Cite journal  | last1 = Kumar | first1 = A. | last2 = Roberts | first2 = D. | last3 = Wood | first3 = KE. | last4 = Light | first4 = B. | last5 = Parrillo | first5 = JE. | last6 = Sharma | first6 = S. | last7 = Suppes | first7 = R. | last8 = Feinstein | first8 = D. | last9 = Zanotti | first9 = S. | title = Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. | journal = Crit Care Med | volume = 34 | issue = 6 | pages = 1589-96 | month = Jun | year = 2006 | doi = 10.1097/01.CCM.0000217961.75225.E9 | PMID = 16625125 }}</ref>


==Dont's==
==Dont's==

Revision as of 00:52, 21 February 2014

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Chetan Lokhande, M.B.B.S [2]

Definition

A lower respiratory tract infection in a previously normal individual acquired through normal social contact rather than contracting it in a hospital.

Causes

Life Threatening Causes

No life threatening causes have been noted. However, complications of pneumonia could lead to life threatening situations like pleural effusion, lung abscess, bacteremia, septicemia or a secondary infection involving other organ systems.

Common Causes

  • Typical Bacteria
  1. Streptococcus pneumoniae
  2. Haemophilus influenzae
  3. Escherichia coli
  4. Klebsiella pneumoniae
  5. Pseudomonas aeruginosa
  • Atypical Bacteria
  1. Mycoplasma pneumoniae
  2. Chlamydophila pneumoniae
  3. Legionella pneumophila
  • Viruses
  1. Influenza
  2. Parainfluenza
  3. Respiratory syncytial virus (RSV)
  4. Metapneumovirus
  5. Adenovirus
Common Etiologies of Community-Acquired Pneumonia
Location Etiologies of Community-Acquired Pneumonia[1][2][3]
 ▸ Outpatient ▸ Streptococcus pneumoniae
▸ Mycoplasma pneumoniae
▸ Haemophilus influenzae
▸ Chlamydophila pneumoniae
▸ Influenza A and B, adenovirus, respiratory syncytial virus, parainfluenza
▸ Inpatient (non-ICU) ▸ Streptococcus pneumoniae
▸ Mycoplasma pneumoniae
▸ Chlamydophila pneumoniae
▸ Haemophilus influenzae
▸ Legionella
▸ Aspiration
▸ Influenza A and B, adenovirus, respiratory syncytial virus, parainfluenza
▸ Yersinia enterocolitica
▸ Inpatient (ICU) ▸ Streptococcus pneumoniae
▸ Staphylococcus aureus
▸ Legionella
▸ Gram-negative bacilli
▸ Haemophilus influenzae
▸ Acinetobacter baumannii

Management

Please find below an algorithm that summarizes the approach to community acquired pneumonia.

Do's

Dont's

References

  1. ↑ Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC, Dowell SF, File TM, Musher DM, Niederman MS, Torres A, Whitney CG (2007). "Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults". Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America. 44 Suppl 2: S27–72. doi:10.1086/511159. PMID 17278083. Unknown parameter |month= ignored (help)
  2. ↑ Wong, KK.; Fistek, M.; Watkins, RR. (2013). "Community-acquired pneumonia caused by Yersinia enterocolitica in an immunocompetent patient". J Med Microbiol. 62 (Pt 4): 650–1. doi:10.1099/jmm.0.053488-0. PMID 23242642. Unknown parameter |month= ignored (help)
  3. ↑ Oh, YJ.; Song, SH.; Baik, SH.; Lee, HH.; Han, IM.; Oh, DH. (2013). "A case of fulminant community-acquired Acinetobacter baumannii pneumonia in Korea". Korean J Intern Med. 28 (4): 486–90. doi:10.3904/kjim.2013.28.4.486. PMID 23864808. Unknown parameter |month= ignored (help)
  4. ↑ "MMS: Error".
  5. ↑ Rivers, E.; Nguyen, B.; Havstad, S.; Ressler, J.; Muzzin, A.; Knoblich, B.; Peterson, E.; Tomlanovich, M. (2001). "Early goal-directed therapy in the treatment of severe sepsis and septic shock". N Engl J Med. 345 (19): 1368–77. doi:10.1056/NEJMoa010307. PMID 11794169. Unknown parameter |month= ignored (help)
  6. ↑ "Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia". Am J Respir Crit Care Med. 171 (4): 388–416. 2005. doi:10.1164/rccm.200405-644ST. PMID 15699079. Unknown parameter |month= ignored (help)
  7. ↑ Lim, HF.; Phua, J.; Mukhopadhyay, A.; Ngerng, WJ.; Chew, MY.; Sim, TB.; Kuan, WS.; Mahadevan, M.; Lim, TK. (2013). "IDSA/ATS minor criteria aided pre-ICU resuscitation in severe community-acquired pneumonia". Eur Respir J. doi:10.1183/09031936.00081713. PMID 24176994. Unknown parameter |month= ignored (help)
  8. ↑ Wilson, KC.; Schünemann, HJ. (2011). "An appraisal of the evidence underlying performance measures for community-acquired pneumonia". Am J Respir Crit Care Med. 183 (11): 1454–62. doi:10.1164/rccm.201009-1451PP. PMID 21239689. Unknown parameter |month= ignored (help)
  9. ↑ Kumar, A.; Roberts, D.; Wood, KE.; Light, B.; Parrillo, JE.; Sharma, S.; Suppes, R.; Feinstein, D.; Zanotti, S. (2006). "Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock". Crit Care Med. 34 (6): 1589–96. doi:10.1097/01.CCM.0000217961.75225.E9. PMID 16625125. Unknown parameter |month= ignored (help)

Template:WH Template:WS

Retrieved from "https://www.wikidoc.org/index.php?title=Community_acquired_pneumonia_resident_survival_guide&oldid=946173"