Pneumonia Pathophysiology 2012 (1)

Utility is highly dependent upon quality of specimen

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Utility is highly dependent upon quality of specimen (variable) Good specimen will yield: » A primary pathogen » Predominance of neutrophils or WBCs » Low proportion of squamous epithelial cells Blood culture Generally recommended in hospitalized patients Low positivity rate (7-16%) Diagnostic Testing and Laboratory Data *40% of patients with pneumonia are unable to produce sputum *As little as 14% of specimens were found to be adequate in recent studies
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Key Steps for Evaluating Pneumonia Consider patient location Community acquired pneumonia (CAP) Hospital acquired pneumonia (HAP) Ventilator associated pneumonia (VAP) Healthcare associated pneumonia (HCAP) Consider underlying disease states Immune suppressed (HIV/AIDS) Determining Potential Microbiologic Causes
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Key Steps for Evaluating Pneumonia Community acquired pneumonia (CAP) Pneumonia in patients who are: Not currently hospitalized AND Do not have a recent history of healthcare exposures** **Please see definition for HCAP** Determining Potential Microbiologic Causes
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Microbiology and Pathogen Prevalence Streptococcus pneumoniae 20-60% Haemophilus influenzae 3-10% Moraxella catarrhalils 1-2% Mycoplasma pneumoniae 5-20% Legionella pneumophila 2-15% Chlamydia pneumoniae 1-15% Viral causes 10-30% Pathogen* Prevalence Community Acquired Pneumonia *Empiric antibiotics should provide coverage for bacterial pathogens
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Microbiology and Pathogen Prevalence Community Acquired Pneumonia Streptococcus pneumonia Gram positive cocci Pairs and chains Protective capsule Infections Upper/lower respiratory Most common in CAP Meningitis Increasing resistance to penicillin
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Key Steps for Evaluating Pneumonia Additional diagnostic tests for CAP Bacterial urinary antigen assays Detect the presence of bacterial antigens in urine during the acute phase of infection Streptococcus pneumonia and Legionella pneumophila Advantages Rapid results (~15 minutes) Remain + after antibiotics are started Adds to diagnostic data – especially when uncertain Disadvantages Unable to provide antibiotic sensitivity data Legionella serogroup 1 only Determining Potential Microbiologic Causes
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Key Steps for Evaluating Pneumonia Hospital acquired pneumonia (HAP) Pneumonia ≥ 48 hours after hospital
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