APhA2023 CAPsLocked: Bacterial Pneumonia Questions PDF

CAPsLocked: Your Arsenal Against Bacterial Pneumonia Kimmy Nguyen, PharmD, BCACP, BC-ADM, TTS CPE Information Target Audience: ACPE#: Activity Type: (APhA will complete this information.)  – Learning Objectives Identify the organisms that cause community-acquired pneumonia 1...

CAPsLocked: Your Arsenal Against Bacterial Pneumonia Kimmy Nguyen, PharmD, BCACP, BC-ADM, TTS CPE Information Target Audience: ACPE#: Activity Type: (APhA will complete this information.)  – Learning Objectives Identify the organisms that cause community-acquired pneumonia 1 (CAP) List the risk factors for drug-resistant Streptococcus pneumoniae, 2 MRSA, and Pseudomonas aeruginosa Describe new therapeutics for the treatment of community- 3 acquired bacterial pneumonia Given a patient case, design an appropriate treatment plan based 4 on current evidence  – Assessment Question 1. Which pathogen is the most common cause of bacterial pneumonia? A. Staphylococcus aureus B. Streptococcus pneumoniae C. Chlamydia pneumoniae D. Legionella pneumophila  – Assessment Question 2. Which risk factor is associated with MRSA or P. aeruginosa infection? A. Age older than 65 years B. Prior respiratory isolation of methicillin-susceptible Staphylococcus aureus (MSSA) C. Hypotension requiring aggressive fluid resuscitation D. Recent hospitalization with receipt of parenteral antibiotics within the past 90 days  – Assessment Question 3. Which statement is correct regarding lefamulin? A. Lefamulin should be avoided in patients with ventricular arrhythmias. B. Lefamulin is a tetracycline derivative that binds to the 30S ribosomal subunit to inhibit protein synthesis. C. Lefamulin demonstrated superiority to moxifloxacin for the treatment of CAP. D. Lefamulin is can treat CAP regardless of causative pathogen.  – Assessment Question 4. A 65-year-old patient is being treated for severe pneumonia in the inpatient setting. A fluoroquinolone allergy is noted in the chart. No risk factors for MRSA or P. aeruginosa identified. Which regimen is most appropriate? A. Levofloxacin B. Ceftriaxone + Levofloxacin C. Ceftriaxone + Azithromycin D. Ceftriaxone + Azithromycin + Vancomycin Background on Community- acquired Pneumonia  – Clinical Case Irene is a 67-year-old who presents to an urgent care clinic with complaints of new onset fever and cough with purulent sputum. She is found to have a decline in oxygenation and multilobar infiltrates on imaging. Past Medical History Vitals COPD T 100°F Type 2 diabetes BP 102/78 mm Hg Hypertension HR 102 bpm Dyslipidemia RR 36 breaths/min 9  – Pneumonia Background New lung infiltrate plus clinical New onset fever evidence that the infiltrate is of an Purulent sputum infectious origin Leukocytosis Decline in oxygenation 9 States thleading cause of death in the United 2 Mortality rate of 14.4 per 100,000 based on 2020 ndmost common infectious cause of death data 1.5 million emergency room visits $7.7 740,700inpatient stays billion NCHS. CDC WONDER Online Database. 2020. Kalil AC, et al. Clin Infect Dis. 2016. Murphy SL, Kochanek KD, Xu JQ, et al. NCHS. Cairns C, Kang K, Santo L. NHAMCS. 2018. United states icon: Flaticon.com. Created by Nikita Golubev. 1  – Community-Acquired Pneumonia CAP = Pneumonia acquired outside of healthcare settings Typical Pathogens Atypical Pathogens Streptococcus Mycoplasma pneumoniae pneumoniae Haemophilus influenzae Chlamydia Staphylococcus aureus pneumoniae Moraxella catarrhalis Legionella spp Changing microbial etiology due to widespread introduction of the pneumococcal conjugate vaccine and increased recognition of viral pathogens Metlay JP, et al. Am J Respir Crit Care Med. Shoar S, Musher DM. Pneumonia. 2020. Kalil AC, et al. Clin Infect Dis. Mandell LA, et al. Clin Infect Dis. 1  – Gram Stains and Cultures Diagnosis based on clinical features (fever, cough, dyspnea, sputum production) and infiltrate on chest imaging Receiving empiric treatment for Outpatient Management MRSA or P. aeruginosa Sputum Gram stain and culture Previous infection with MRSA or P. not routinely recommended aeruginosa, especially in those with a prior respiratory tract Inpatient Management infection Pretreatment sputum Gram stain Hospitalized and received and culture and blood culture parenteral antibiotics in the last 90 recommended in severe CAP days and in the following situations Mandell LA, et al. Clin Infect Dis. 2007. Metlay JP, et al. Am J Respir Crit Care Med. 2019. 1  – Determining Site of Care Hospitalization Symptom (1 point for each item) Use a validated clinical C Confusion* prediction tool for prognosis U Urea >7 mmol/L as an adjunct to clinical R Respiratory Rate ≥30 bpm judgment B Blood Pressure (SBP