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Pneumonia (Treatment (Steroids (May speed up clinical stabilization and…

- - - - 5-7 days if stable and afebrile for 48-72 hours
    - - 8 days
      - Exception: 15 days for pseudomonas or other GNR
- - - - Sputum for AFB stain & Mycobaterial culuture --> Rapid DNA probe if AFB +
      - Empiric respiratory isolation while pending
      - Avoid quinolone if suspecting TB
    - - Induced sputum for PCP if HIV + or known ↓ cell mediated immunity
  - - - may take >72 h to see improvement (fever persistent >4 days in 20% cases)
    - - for lung penetration
      - e.g. Vanc trough <15-20 ug/ml
    - - e.g. MRSA,Pseudomonas: Consider bronchoscopy
    - - Fungal/viral, Chemical pneumonitis, Pulmonary embolism, CHF, ARDS, Diffuse alveolar hemorrhage, ILD: Consider CT
    - - Consider CT
      - Diagnostic tap
      - Chest tube if effusion + esp. if loculated
    - - e.g. endocarditis, meningitis, septic arthritis
- - - - S.aureus, Pseudomonas, Klebsiella, E.Coli, Enterobacter, Acinetobacter
      - Risk Factors
        
        Hospital or antibiotics w/in 90 days
        
        Nursing home
        
        Home infusion treatment or dialysis w/in 30 days
        
        Home wound care
        
        Family member with multi-drug resistant pathogen
        
        Immunosuppresion
  - - - ≥ 24-72 h after aspiration event
      - Out-pt: Oral flora (Strep. pneumo, S.aureus, Anaerobes)
      - In-pt or chronically ill: GNR(pseudomonas), S.aureus
  - - - No pathogen identified in 50-60%.
      - Viral alone ~ 25%
        
        Influenza, RSV, hMPV (human metapneumovirus), Rhinovirus, parainfluenza, coronavirus
      - Bacterial alone ~ 10%
        
        S.pneumoniae (most common), S.aureus (eps.post influenza), Mycoplasma & Chlamydia (esp. in young & healthy), H.influenzae & Moraxella catarrhalis (esp in COPD), Legionella (esp in elderly, smokers, ↓ Immunity, TNF inhibitors), Klebsiella & other Gram-negative Rods (esp alcoholics and aspiration)
      - Virus-bacterial connection ~ < 5%