Community Acquired Pneumonia Overview

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Questions and Answers

What does Community Acquired Pneumonia (CAP) refer to?

Pneumonia that begins within 48 hours of hospital admission

Pneumonia occurring after intubation

Pneumonia that develops in a healthcare setting

Pneumonia that develops in an outpatient setting (correct)

What differentiates Ventilator Associated Pneumonia (VAP) from Hospital Acquired Pneumonia (HAP)?

VAP occurs before a patient is admitted to the hospital

HAP occurs after intubation while VAP occurs before

HAP can never occur in intubated patients

VAP starts within 48 hours after intubation (correct)

What term was discontinued in pneumonia diagnosis guidelines since 2019?

Community Acquired Pneumonia

Ventilator Associated Pneumonia

Healthcare Associated Pneumonia (correct)

Atypical pneumonia

How is Atypical pneumonia characterized?

By symptoms distinct from classic pneumonia presentations Signup and view all the answers

Which vaccine was introduced most recently among the pneumococcal vaccines mentioned?

PCV13 Signup and view all the answers

When was Pneumococcus isolated by Louis Pasteur and George Sternberg?

1881 Signup and view all the answers

What is the definition of Hospital Acquired Pneumonia (HAP)?

Pneumonia developing in a patient after 48 hours of hospital admission Signup and view all the answers

What characterizes community acquired pneumonia (CAP)?

It is associated with an acute infiltrate on chest radiograph. Signup and view all the answers

What is the average length of hospital stay for patients with community acquired pneumonia?

5.2 days Signup and view all the answers

Which type of pneumonia is identified by the presence of classic lobar opacity on a chest X-ray?

Pneumonia caused by pneumococcus Signup and view all the answers

Which of the following is NOT a primary focus of antibiotic stewardship in managing community-acquired pneumonia?

Reducing hospital readmission rates Signup and view all the answers

What is the incidence rate of community acquired pneumonia as reported?

24.8 cases per 10,000 Signup and view all the answers

Which of the following is the 13th leading cause of death in the US when combined with influenza?

Community acquired pneumonia Signup and view all the answers

What type of infection does community acquired pneumonia result from?

An acute infection of the pulmonary parenchyma Signup and view all the answers

Which novel antibiotic was introduced specifically for the treatment of pneumonia in 2019?

Lefamulin Signup and view all the answers

Which tool is used for analyzing mortality risk in patients with community acquired pneumonia?

Validated risk stratification tools Signup and view all the answers

What is the primary recommendation for Legionella UAT in patients?

Recommended for severe CAP/ICU admission and those with recent travel history Signup and view all the answers

What should be used to diagnose COVID-19 in symptomatic individuals regardless of vaccination status?

Nucleic Acid Amplification Tests (NAATs) and antigen tests Signup and view all the answers

In which situation is procalcitonin most beneficial according to the guidelines?

For de-escalating antibiotic therapy Signup and view all the answers

What testing approach is suggested for influenza during flu season?

Rapid influenza molecular assays over rapid antigen tests Signup and view all the answers

Which biomarkers may be used in the context of COVID-19 and bacterial pneumonia according to the guidelines?

Procalcitonin and CRP Signup and view all the answers

Which of the following pathogens is NOT classified as an atypical pathogen in pneumonia?

Streptococcus pneumoniae Signup and view all the answers

What is the primary purpose of pneumococcal vaccinations?

Prevent invasive disease such as bacteremia Signup and view all the answers

Which factor is NOT considered in the risk stratification for pneumonia?

Presence of facial injuries Signup and view all the answers

Which is a predominant symptom of typical Community Acquired Pneumonia (CAP)?

Pleuritic chest pain Signup and view all the answers

Which of the following vaccines is a 23-valent pneumococcal polysaccharide vaccine?

PPSV23 (Pneumovax23) Signup and view all the answers

What diagnostic test is primarily used to confirm Community Acquired Pneumonia in outpatient settings?

Chest X-ray (CXR) Signup and view all the answers

Which population is specifically targeted for pneumococcal vaccination?

Elderly age > 65 Signup and view all the answers

For patients with suspected severe CAP, which of the following actions should be taken prior to treatment?

Send sputum for culture if such a sample can be gathered Signup and view all the answers

What is the primary imaging study recommended for diagnosing Community-Acquired Pneumonia (CAP)?

Chest radiograph Signup and view all the answers

In patients with severe CAP, what is the purpose of sending blood cultures?

To detect potential bacterial infections Signup and view all the answers

When is urinary antigen testing specifically recommended?

For patients with severe CAP and ICU admission Signup and view all the answers

What is a notable limitation of sputum cultures in diagnosing CAP?

They are difficult to obtain in the emergency department Signup and view all the answers

Why is a CT scan not typically preferred for diagnosing CAP despite its better sensitivity?

There is insufficient evidence that it improves patient outcomes compared to CXR Signup and view all the answers

Which urinary antigen test is specifically recommended for patients with severe CAP?

Pneumococcal Urine Antigen Test Signup and view all the answers

What is the purpose of performing a Chest ultrasound in the context of pneumonia?

To guide thoracentesis and assess pleural effusion Signup and view all the answers

What is a significant finding in blood cultures for patients with severe CAP?

Only about 20% of admitted patients have positive blood cultures Signup and view all the answers

Study Notes

Community Acquired Pneumonia (CAP)

An acute infection of the lung affecting the parenchyma, accompanied by a constellation of suggestive features and acute infiltrate on chest x-ray
Develops in a patient who is NOT hospitalized or residing in a long-term facility
Incidence: 24.8 cases per 10,000
Average length of stay: 5.2 days
13th leading cause of death in the US (combined with influenza)

CAP, HAP, VAP By Setting

Community-acquired pneumonia develops in the outpatient setting
Hospital-acquired pneumonia develops within 48 hours of admission to a hospital in a non-intubated patient
Ventilator-associated pneumonia is HAP that begins within 48 hours after intubation

Atypical Pneumonia and Atypical Pathogens

Atypical pneumonia refers to pneumonia presenting with symptoms or chest x-ray distinct from classic cases.
Atypical pathogens include Mycoplasma pneumoniae, Chlamydophila (Chlamydia) pneumoniae, Legionella pneumophila
Streptococcus pneumoniae is the most common pathogen

CAP Prevention

Pneumococcal vaccinations prevent invasive disease like bacteremia
Target groups: Elderly age 65+, immunocompromised, alcoholics, those with liver disease, chronic heart disease, sickle cell, asplenia
PCV 15, PCV 20, PCV 21, PPSV23 are available

CAP Diagnosis

Must have clinical features of pneumonia on history and physical examination
Radiographic evidence- chest x-ray to be obtained when CAP is suspected
Predominant symptoms: Cough, fevers, chills, dyspnea, pleuritic chest pain, purulent sputum

CAP Differential Diagnosis

Bronchitis (acute or exacerbation of COPD)
COVID-19
Acute coronary syndrome
Heart failure and pulmonary edema
Pulmonary embolism
Bronchogenic carcinomas
Metastatic disease
Radiation pneumonitis

Outpatient vs Inpatient Diagnostic Testing

Outpatient- CXR is the only diagnostic test of value
Inpatient- CXR, pre-treatment blood cultures, sputum cultures if a sample can be obtained, CBC, CMP, viral PCR
Severe CAP/Critically Ill- CXR, blood and sputum cultures + PCR viral tests, CBC, CMP, coagulation studies, serum lactate, PCT, urine antigen tests for legionella and pneumococcus, ABG

Diagnostic Testing

Chest x-ray is recommended to confirm the diagnosis
CT scans have higher sensitivity but no evidence that outcomes are improved over CXR
Chest ultrasound can assess for pleural effusion and guide thoracentesis
Blood cultures are only recommended in severe CAP and patients with recent hospitalization or antibiotic therapy (within 90 days)
Sputum cultures may be helpful in severe CAP

Urine Antigen Testing (UAT)

Pneumococcal UAT is recommended for severe CAP specifically for streptococcus penumonia or legionella
Legionella UAT is recommended for severe CAP/ICU admission and patients with recent travel or known outbreak
Used for outpatient treatment failure
Legionella is associated with travel (cruise ships, spas, hotels)

Influenza Testing

Rapid influenza molecular assay is recommended over rapid influenza diagnostic tests (antigen testing) during flu season
UCSF has specific testing guidelines during summer months

SARS-CoV-2 Testing

Diagnostic testing for people with signs or symptoms of COVID-19, regardless of vaccination status
Nucleic Acid Amplification Tests (NAATs) and Antigen tests

Biomarkers

Procalcitonin is not recommended for guiding antibiotic therapy, but may be useful in de-escalating therapy
May be helpful for assessing COVID-19 vs bacterial pneumonia
C-reactive protein (CRP) may be elevated in both COVID-19 and bacterial pneumonia

Summary of Diagnostic Testing

Extensive diagnostic testing is helpful for patients with risk factors for severe CAP requiring ICU admission
Trend away from automatic blood cultures for non-severe CAP admitted to the floor

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Description

This quiz explores community-acquired pneumonia (CAP), including its incidence, features, and comparison to hospital-acquired and ventilator-associated pneumonia. It also delves into atypical pneumonia and the pathogens responsible. Test your knowledge on these critical respiratory conditions.