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11/28/12

Community-Acquired Pneumonia (CAP) vs. Hospital-Acquired Pneumonia (HAP) :: Community Acquir

Community-Acquired Pneumonia http://medicine.osu.edu/

What is Pneumonia? Community-Acquired Pneumonia (CAP) vs. Hospital-Acquired Pneumonia (HAP) Public Health Perspective

Community-Acquired Pneumonia (CAP) vs. HospitalAcquired Pneumonia (HAP)


Home > What is Pneumonia? > Community-Acquired Pneumonia (CAP) vs. Hospital-Acquired Pneumonia (HAP) Community-Acquired Pneumonia (CAP) Hospital-Acquired Pneumonia (HAP) Presentation Necessary features for diagnosis: Cough Fever CXR infiltrate(s) Incidence Common and increasing Risks Age Cormorbidities: Pulmonary disease Cardiac disease Liver disease Renal disease Preceding influenza Alcohol abuse Tobacco abuse Immunosuppression HIV/AIDS Chronic corticosteroid use Most Common Pathogens Streptococcus pneumoniae Enteric Gram negative bacilli Variable clinical features: Fever Leukocytosis Increased respiratory secretions CXR infiltrate(s) Common and increasing Mechanical ventilation ICU admission Aspiration risks: Swallowing dysfunction Supine positioning Tracheal intubation Tracheostomy Oropharyngeal microbial colonization Elevated gastric pH Immunosuppression Hyperglycemia/Poor glycemic control

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11/28/12

Streptococcus pneumoniae Mycoplasma pneumoniae Chlamydophila pneumoniae Respiratory viruses Legionella pneumophilia Hemophilus influenza Moraxella catarhalis

Community-Acquired Pneumonia (CAP) vs. Hospital-Acquired Pneumonia (HAP) :: Community Acquir

Enteric Gram negative bacilli Pseudomonas aeruginosa Staphylococcus aureus

Less Common Pathogens Enteric Gram negative bacilli Pseudomonas aeruginosa Staphylococcus aureus Streptococcus pneumonaie other Strep sp. Hemophilus influenza Acinetobacter sp. Stenotrophomonas Legionella pneumophilia Influenza Candida sp.

Diagnosis Cough Fever CXR infiltrate Precise role for microbiologic cultures is unclear. Empiric Treatment(s) Respiratory Fluoroquinolone (R-FQ) Macrolides Beta-lactams Prevention Influenza vaccination Pneumococcal vaccination Smoking cessation Treat comorbities Avoid invasive mechanical ventilation Infection control measures Elevate head-of-bed Subglottic suctioning Oral / pharyngeal decontamination Maintain gastric acidity anti-Pseudomonal beta-lactams anti-Pseudomonal fluoroquinolones Aminoglycosides Vancomycin or Linezolid Clinical features are unreliable (fever, leukocytosis, new CXR infiltrate) Bronchoalveolar lavage (BAL) or Protected specimen brush (PSB) with quantitative cultures Suctioned / expectorated sputum Serial CXRs or chest CT scanning

The Ohio State University | College of Medicine Division of Pulmonary, Allergy, Critical Care & Sleep Medicine

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