Pneumonia

• What are some risk factors for pneumonia?

  Age <5 or >65 years old

  Smoking

  Recent viral resp tract infection

  Chronic resp diseases

  Immunosuppression

  IV drug users

  Diabetes

  CVD
• What bacteria most commonly causes CAP?

  Streptococcus pneumoniae
• Which bacteria most commonly causes pneumonia in those with COPD?

  Haemophilus influenzae
• Which bacteria most commonly causes pneumonia post-influenza and nosocomial settings?

  Staphylococcus aureus
• Which bacteria most commonly causes pneumonia in alcoholics and those with impaired swallowing?

  Klebsiella
• Which bacteria most commonly causes pneumonia in those with cystic fibrosis or immunocompromised states?

  Pseudomonas aeruginosa
• What is the most common cause of viral pneumonia?

  Influenza
• Which virus is the most common cause of pneumonia in infants and elderly?

  RSV
• What is CAP?

  Develop pneumonia within the community
• What is HAP?

  Pneumonia that occurs >48 hours after admission
• What is ventilator-associated pneumonia?

  Pneumonia that develops >48 hours after endotracheal intubation
• How may a patient present with pneumonia?

  Cough

  Dyspnoea

  Pleuritic chest pain

  Fever

  Malaise

  Fatigue

  Anorexia
• What are some physical examination findings for pneumonia?

  Tachypnoea

  Tachycardia

  Hypoxia

  Crackles (auscultation)
• What are some first-line investigations for pneumonia?

  CXR

  Bloods

  Sputum culture

  Gram stain
• What bloods are done for pneumonia?

  FBC

  CRP

  U&Es

  LFTs

  ABGs
• What are some further investigations for pneumonia if there is not a clear diagnosis or if it is severe?

  Blood cultures

  Pleural fluid analysis

  Urinary antigen tests

  Bronchoscopy
• What are some ddx for pneumonia?

  Bronchitis

  TB

  Lung cancer
• What criteria is used to assess pneumonia?

  CRB65 - primary care

  CURB65 - secondary care
• What does CURB65 stand for?

  Confusion

  Urea

  Resp rate

  BP

  65+ age
• What does a CURB65 score of 0-1 mean regarding management?

  Home-based care (low risk)
• What does a CURB65 score of 2+ mean regarding pneumonia management?

  Consider hospital-based care (intermediate risk)
• What does a CURB65 score of 3+ mean regarding pneumonia management?

  Consider intensive care assessment (high risk)
• What is the management of low severity CAP?

  Amoxicillin (firstline)

  If ALLERGIC to penicillin then macrolide or tetracycline
• What is the management of moderate and high severity CAP?

  Dual antibiotic therapy - amoxicillin + macrolide
• What does NICE recommend for the management of high severity CAP?

  beta-lactamase stable penicillin (e.g. co-amox) + tazobactam + macrolide
• What are some pulmonary complications of pneumonia?

  Pleural effusion

  Empyema

  Lung abscess

  Acute resp distress

  Pneumothorax
• What are some extrapulmonary complications of pneumonia?

  Bacteremia + sepsis

  Metastatic infections

  Pericarditis

  AKI