What is the difference between hospital and community acquired pneumonia?
Pneumonia is generally classified into two types – community acquired pneumonia and nosocomial (hospital acquired) pneumonia. In the former case the causative pathogens are primarily viruses and gram positive bacteria while in the later case the causative pathogens are primarily gram negative organisms.
What are the most common causes of community acquired pneumonia?
Pneumonia is a common illness that affects millions of people each year in the United States. Germs called bacteria, viruses, and fungi may cause pneumonia. In adults, bacteria are the most common cause of pneumonia. Ways you can get pneumonia include: Bacteria and viruses living in your nose, sinuses, or mouth may spread to your lungs.
What is community acquired?
What is Community Acquired Infection? Community-acquired infections are the infections that patients contract outside the hospital. In other words, they are the infections that become clinically apparent within 48 hours of the hospital admission or has had the infection when admitted to the hospital for some other reason.
What is the first line treatment for pneumonia?
• Nonresolving pneumonia may be because of less common pathogens, or feature other conditions, and requires more detailed investigation. • Pediatric pneumonia is also common, and first-line treatment is still amoxicillin, followed closely by cephalosporins or macrolides.
What is the best treatment for community-acquired pneumonia?
The initial treatment of CAP is empiric, and macrolides or doxycycline (Vibramycin) should be used in most patients.
What is the first line treatment for hospital acquired pneumonia?
In general, for both hospital-acquired pneumonia (HAP) and VAP, 7 days of treatment with appropriate antibiotics/antibiotics is recommended. This duration may be shortened or lengthened depending on the clinical response of the individual.
When Should a hospital be hospitalized for hats?
Although patients with mild community-acquired pneumonia (CAP) may be treated in an ambulatory setting, patients with CAP who are moderately to severely ill should be hospitalized.
What is the standard empiric regimen recommended for inpatient treatment of non severe CAP?
The standard recommended empirical regimen for inpatients with nonsevere pneumonia is a beta-lactam plus a macrolide or a respiratory fluoroquinolone alone.
When is hospitalization necessary for pneumonia?
Your cough is worse or you cough up blood or rust-colored mucus. Your breathing is more difficult — for example it's faster, more shallow, or more painful than before. You become lightheaded or very weak. You develop a fever higher than 102° F or you have shaking chills.
Should pneumonia patients be hospitalized?
Most people recover completely from pneumonia, especially those who do not require hospitalization. However, in some cases, it can be fatal. The risk of death is higher in people who are hospitalized, particularly those who are admitted to the intensive care unit (ICU).
How would you treat this patient hospitalized with community-acquired pneumonia?
Antibiotic recommendations for hospitalized patients with CAP are divided by the site of care (medical ward or intensive care unit [ICU]). Most hospitalized patients are initially treated with an intravenous (IV) regimen but can transition to oral therapy as they improve.
Which regimen is the preferred treatment for community-acquired pneumonia according to the 2019 IDSA guidelines?
a beta-lactam plus a respiratory fluoroquinolone (strong recommendation, low quality of evidence).
What is empiric treatment for community-acquired pneumonia?
Consensus guidelines from several organizations recommend empiric therapy with macrolides, fluoroquinolones, or doxycycline. Patients who are hospitalized should be switched from parenteral antibiotics to oral antibiotics after their symptoms improve, they are afebrile, and they are able to tolerate oral medications.
What is HCAP in healthcare?
Health care-associated pneumonia (HCAP; no longer used) referred to pneumonia acquired in health care facilities (eg, nursing homes, hemodialysis centers) or after recent hospitalization [ 6,7 ]. The term HCAP was used to identify patients at risk for infection with multidrug-resistant pathogens.
How long does it take for a patient to respond to antibiotics?
Clinical response to therapy — With appropriate antibiotic therapy, some improvement in the patient's clinical course is usually seen within 48 to 72 hours ( table 8 ). Patients who do not demonstrate some clinical improvement within 72 hours are considered nonresponders.
Does vancomycin reduce MIC?
One concern with vancomycin is the increasing minimum inhibitory concentrations (MICs) of MRSA that have emerged in recent years, which may reduce the efficacy of vancomycin in pulmonary infection. In patients with a MRSA isolate with an increased vancomycin MIC (≥2 mcg/mL), we prefer linezolid.
Do cephalosporins increase the risk of C. difficile?
Nevertheless, cephalosporins and other antibiotic classes also increase the risk of C. difficile infection. (See "Clostridioides (formerly Clostridium) difficile infection in adults: Epidemiology, microbiology, and pathophysiology", section on 'Antibiotic use' .)
Is CAP a serious illness?
CAP is a common and potentially serious illness [ 1-5 ]. It is associated with considerable morbidity and mortality, particularly in older adult patients and those with significant comorbidities. (See "Prognosis of community-acquired pneumonia in adults" .)
Is omadacycline FDA approved?
Omadacycline is US Food and Drug Administration (FDA) approved for the treatment of CAP and has in vitro activity against common atypical and typical CAP pathogens, MRSA, many gram-negative rods (but not Pseudomonas spp), and anaerobes [ 124,125 ].
What are the signs of pneumonia?
Signs of pneumonia on physical examination include tachypnea, increased work of breathing, and adventitious breath sounds, including rales/crackles and rhonchi. Tactile fremitus, egophony, and dullness to percussion also suggest pneumonia.
What is CAP in lung?
Traditionally, CAP has been viewed as an infection of the lung parenchyma, primarily caused by bacterial or viral respiratory pathogens. In this model, respiratory pathogens are transmitted from person to person via droplets or, less commonly, via aerosol inhalation (eg, as with Legionella or Coxiella species).
What are the risk factors for CA-MRSA?
Risk factors for CA-MRSA infection include a history of MRSA skin lesions, participation in contact sports, injection drug use, crowded living conditions, and men who have sex with men. (See "Methicillin-resistant Staphylococcus aureus (MRSA) in adults: Epidemiology" .)
What is HCAP in healthcare?
Health care-associated pneumonia (HCAP; no longer used) referred to pneumonia acquired in health care facilities (eg, nursing homes, hemodialysis centers) or after recent hospitalization. The term HCAP was used to identify patients at risk for infection with multidrug-resistant pathogens.
What is CAP in medical terms?
Community-acquired pneumonia (CAP) is a leading cause of morbidity and mortality worldwide. The clinical presentation of CAP varies, ranging from mild pneumonia characterized by fever and productive cough to severe pneumonia characterized by respiratory distress and sepsis.
Why is CAP important?
Because of the wide spectrum of associated clinical features, CAP is a part of the differential diagnosis of nearly all respiratory illnesses. This topic provides a broad overview of the epidemiology, microbiology, pathogenesis, clinical features, diagnosis, and management of CAP in immunocompetent adults.
Can HCAP be treated with CAP?
In general, patients previously classified as having HCAP should be treated similarly to those with CAP. (See "Epidemiology, pathogenesis, microbiology, and diagnosis of hospital-acquired and ventilator-associated pneumonia in adults" .) EPIDEMIOLOGY.
Definition
- INTRODUCTION Community-acquired pneumonia (CAP) is defined as an acute infection of the pulmonary parenchyma in a patient who has acquired the infection in the community, as distinguished from hospital-acquired (nosocomial) pneumonia (HAP).
Prognosis
- CAP is a common and potentially serious illness [1-5]. It is associated with considerable morbidity and mortality, particularly in older adult patients and those with significant comorbidities. (See \"Prognosis of community-acquired pneumonia in adults\".)
Clinical significance
- Pneumonia in special populations, such as aspiration pneumonia, immunocompromised patients, HAP, and ventilator-associated pneumonia (VAP) are also discussed separately. (See \"Aspiration pneumonia in adults\" and \"Pulmonary infections in immunocompromised patients\" and \"Treatment of hospital-acquired and ventilator-associated pneumonia in adults\".)
Healthcare
- MANAGEMENT OF HEALTHCARE-ASSOCIATED PNEUMONIA Healthcare-associated pneumonia (HCAP) was included in prior hospital-acquired pneumonia (HAP) guidelines [6] (but not current HAP guidelines [7]) to identify patients thought to be at increased risk for multidrug-resistant (MDR) pathogens coming from community settings. HCAP referred to pneumonia acquired in he…
Risks
- Another risk factor is prior exposure to the healthcare setting such as from prior hospitalization or from residence in a long-term care facility. Although several studies have suggested a survival benefit to early initiation of antibiotics, some experts have questioned whether it is an independent risk factor for this outcome. It is important to note, however, that a delay in antimicr…
Treatment
- Recent therapy or a repeated course of therapy with beta-lactams, macrolides, or fluoroquinolones are risk factors for pneumococcal resistance to the same class of antibiotic [18]. Thus, an antimicrobial agent from an alternative class is preferred for a patient who has recently received one of these agents. INITIAL EMPIRIC THERAPY Antibiotic therapy is typically begun o…
Diagnosis
- DIAGNOSTIC TESTING The approach to diagnostic testing for hospitalized patients with CAP is summarized in the following table (table 4). In addition to the tests recommended in the table, we recommend testing for a specific organism when, based on clinical or epidemiologic data, pathogens that would not respond to usual empiric therapy are suspected (table 5) [2]. These in…
Preparation
- Tests that are indicated (especially sputum Gram stain and culture and blood cultures) should ideally be performed before antibiotics have been started. However, initiation of treatment should not be delayed if it is not possible to obtain specimens immediately (eg, if the patient cannot produce a sputum specimen).
Uses
- The Gram stain of respiratory secretions can be useful for directing the choice of initial therapy if performed on a good quality sputum sample and interpreted by skilled examiners using appropriate criteria [2]. (See \"Diagnostic approach to community-acquired pneumonia in adults\", section on 'Sputum'.)
Management
- Timing of antibiotics We generally start antibiotic therapy as soon as we are confident that CAP is the appropriate working diagnosis and, ideally, within four hours of presentation for patients being admitted to the general medical ward [2,27]. In patients with sepsis or septic shock, antibiotics should be started within one hour. (See \"Evaluation and management of suspected sepsis and …
Research
- A 2016 systematic review included eight studies that evaluated time to initiation of antibiotics and noted that all of the studies were observational in design and therefore represented low-quality evidence [28]. The four studies that showed an association between early initiation of antibiotics and reduced mortality were the largest of the studies, and three of them included patients 65 ye…
Administration
- Route of administration Generally, we favor administration of IV antibiotics for patients hospitalized for CAP at the start of therapy because of the high mortality associated with CAP and the uncertainty of adequate gastrointestinal absorption or oral antibiotics in severely ill patients. Upon clinical improvement, IV antibiotics can be transitioned to oral therapy (see 'Switching to o…
Contraindications
- Penicillin and cephalosporin allergy For penicillin-allergic patients, the type and severity of reaction should be assessed. Individuals with a past reaction to penicillin that was mild (not Stevens Johnson syndrome, toxic epidermal necrolysis, or drug reaction with eosinophilia and systemic symptoms [DRESS]) and did not have features of an IgE-mediated reaction can receiv…
Adverse effects
- Furthermore, the severity of adverse effects (including the risk for C. difficile infection) and the risk of selection for resistance in colonizing organisms are generally thought to be greater with fluoroquinolones than with other antibiotic classes. Nevertheless, cephalosporins and other antibiotic classes also increase the risk of C. difficile infection. (See \"Clostridioides (formerly Cl…
Prevention
- With risk factors for Pseudomonas or resistant gram-negative bacilli In patients who may be infected with P. aeruginosa or other resistant gram-negative pathogens (particularly those with structural lung abnormalities [eg, bronchiectasis], chronic obstructive pulmonary disease [COPD] and frequent antimicrobial or glucocorticoid use, and/or gram-negative bacilli seen on sputum G…
Interactions
- The combination of vancomycin and piperacillin-tazobactam has been associated with acute kidney injury. In patients who require an anti-MRSA agent and an antipseudomonal/antipneumococcal beta-lactam, options include using a beta-lactam other than piperacillin-tazobactam (eg, cefepime or ceftazidime) or, if piperacillin-tazobactam is favored, us…