10/2/2017. Pneumonia: Are We Missing the Mark? Objectives. Pneumonia

Size: px
Start display at page:

Download "10/2/2017. Pneumonia: Are We Missing the Mark? Objectives. Pneumonia"

Transcription

1 Pneumonia: Are We Missing the Mark? LaDawna Goering, DNP, APN, ANP-BC Nick Van Hise, Pharm. D, BCPS Objectives Diagnose Pneumonia Evaluate severity of illness tools and site of care decisions Review diagnostic tests in pneumonia Examine criteria for when to utilize diagnostic testing Analyze the use of quantitative cultures, biomarkers, and antibiogram Apply guidelines for prescribing antibiotics for treatment of CAP, HAP, and VAP Describe pneumonia prevention recommendations: Smoking cessation & Flu and pneumococcal immunization Pneumonia Community Acquired Pneumonia (CAP) affects 5.6 million patients a year 6 th leading cause of death in people > 65 years of age Averages 10.6 per 1,000 per working adults aged18 64 yrs. I million hospital admissions, 10 20% require ICU 140,000 readmissions a year, 1 in 5 within 30 days 50,000 deaths annually Both influenza pneumonia & bacterial pneumonia are associated with post pneumonia cardiac events including arrhythmias, worsening heart failure, and myocardial infarction. An elder adult can take months to recover; the mortality rate /risk remains elevated for 5 years post pneumonia. 1

2 Hospital Acquired/ Ventilator Associated Pneumonias Hospital acquired pneumonia and ventilator associated pneumonia account for 22% of all HAI. Pneumonia has the highest morbidity and mortality rates of all nosocomial infections. 50% of HAP patients suffer from respiratory failure, pleural effusions, septic shock, renal failure, and empyema. VAP estimated to occur in 9 28% of mechanically ventilated patients, VAP has a mortality rate of 3 17%. VAP estimated to prolong the duration of mechanical ventilation by up to 11 days, increase hospitalization stay by 6 25 days, and increase health care cost by $12,000 to $40,000 per episode. (Kallet, 2015) Diagnosis Clinical Diagnosis Cough Fever & Chills Fatigue Sputum Shortness of Breath Pleuritic chest pain 30% of elderly do not have cough, fever, sputum, or elevated wbc Physical Exam Rales/ Bronchial breath sounds May be missing in elderly population Definitive diagnosis = Chest radiograph / CT Diagnostic testing only if alters standard management care (antibiotic coverage) Pneumonia Chest X-ray (Smithuis, 2014) 2

3 Site of Care Decision Hospital Admission most costly Inpatient care for pneumonia 25% more costly than outpatient care Costs an estimated $ billion yearly Mean all age cost per inpatient episode $11,148 $51,219 Mean all age cost per outpatient episode $2,212 Benefits of outpatient treatment include Resume to normal activity sooner 80% prefer outpatient therapy Less risk for acquired infections (Sato, Rey, Nelson & Pinsky, 2013). Severity of Illness Initial Assessment of Severity Hospital vs. Outpatient CURB 65/ CRB65 Confusion, uremia, resp rate, low, blood pressure, age 0 1 outpatient > 2 inpatient (>3 ICU) Pneumonia Severity Index (PSI) Classifies patients into 5 mortality risk classes Recommends I II outpatients III observation/ short stay IV V Hospitalization/ inpatient Site of Care Decision Considerations Complications of pneumonia Exacerbation of underlying disease Rare illness (Sickle cell, neuromuscular disease) Signs or symptoms of severe CAP Borderline score thresholds (CURB/ CRB/ PSI) Psychosocial needs Intractable vomiting Injection drug abuse Psychiatric Illness Homelessness Poor overall functional status Cognitive dysfunction Ability to take oral medication & outpatient support (IDSA & ATS, 2007 & 2016) 3

4 CURB 65/ CRB65 Severity Score Site of Care (Auble et al., 2005) PNEUMONIA SEVERITY INDEX PSI Classifications (Mandell et al., 2007) 4

5 Criteria for Severe Community Acquired Pneumonia Minor criteria Respiratory rate >30 breaths/min PaO2/FiO2 ratio <250 (ratio arterial oxygen partial pressure to fractional inspired oxygen) requires arterial blood sample Multilobar infiltrates requires CXR Confusion/disorientation Uremia (BUN level >20 mg/dl) Leukopenia (WBC count, <4000 cells/mm3 ) Thrombocytopenia (platelet count, <100,000 cells/mm3 ) Hypothermia (core temperature, <36 degrees C) Hypotension requiring aggressive fluid resuscitation Major criteria Invasive mechanical ventilation Septic shock with the need for vasopressors (IDSA & ATS, 2007 & 2016) SMART COP Severe CAP Score of 5 or > (Charles et al., 2008) Criteria for Diagnostic Testing Intensive care unit admission Failure of outpatient antibiotic therapy Cavitary infiltrates Known / suspected Leukopenia Active alcohol abuse Chronic severe liver disease Severe obstructive/structural lung disease Asplenia (anatomic or functional) Recent travel (within past 2 weeks) Positive Legionella Positive pneumococcal Pleural effusion (IDSA & ATS, 2007 & 2016) 5

6 Pneumonia Diagnostic Testing Rapid Point of Care testing Influenza A/B (rapid/ useful for antiviral treatment/ high false negative) Blood cultures (Most common isolate S. pneumoniae) Pretreatment blood cultures for Hospitalized patients Positive 20 25% inpatients Pneumococcal Pneumonia Patients with Severe CAP (Most often S. auerus, P. aeruginosa, and other gram negative bacilli) Asplenia, complement deficiencies, chronic liver disease, leukopenia. Sputum cultures (Most common S. pneumoniae) Gram stain / culture If good sample / obtained within 6 12 hrs of antibiotics Patients with Severe CAP (COPD pts/ alcoholism) higher risk gram negative pathogens / P. Aeruginosa. (IDSA & ATS, 2016) Pneumonia Diagnostic Testing Urinary antigen tests Severe CAP Legionella pneumophilia (continues to be + for weeks) S. pneumoniae (rapid test and detect after can still be detected 3 days after antibiotic therapy) Enzyme linked immunosorbent assay (ELISA) Urine sample/ detects pneumococcal cell wall polysaccharide in 77 88% patients with bacteremic pneumococcal pneumonia 64% nonbacteremic pneumonia ELISA for legionella urinary antigen + 74% Leginonella pneumopila seotype1 PCR Assay Detects Respiratory viruses including influenza, Mycoplasa Pneumoniae, Chlamydophlia pneumoniae 20 40% of CAP hospitalized patients. (IDSA & ATS, 2016) Use of Quantitative Cultures, Biomarkers Recommendations in Suspected Hospital Acquired Pneumonia (non VAP) Respiratory Cultures Consider sputum cough induction / expectoration Nasotracheal suction Blood Cultures Target antibiotic treatment to results of microbiology results Not Recommended at this time for decision on antibiotic therapy Procalcitonin (PCT) clinical criteria is recommended over the use of serum PCT + clinical criteria PCT (0.1 ug/l) used to guide antibiotic discontinuation C reactive protein (CRP) clinical criteria is recommended over the use of CRP+ clinical criteria Soluble Triggering Receptor Expressed on Myeloid Cells (strem 1) (requires bronchial lavage) clinical criteria is recommended over the use of sterm 1+ clinical criteria (IDSA & ATS, 2016) 6

7 Prescribing Antibiotics Hospitals disseminate a local antibiogram specific to their intensive care population Empiric treatment is developed to treat the distribution of local pathogens and susceptibilities for inpatients and outpatients Recommended shorter Length of therapy 7 days. Prescribing Antibiotics Hospitals disseminate a local antibiogram specific to their intensive care population. Empiric treatment should be developed to treat the distribution of local pathogens and susceptibilities. MRSA? Drug resistance?? 7 day of antimicrobial therapy / de escalation Etiology of Community Acquired Pneumonia OUTPATIENT Streptococcus pneumoniae Mycoplasma pneumoniae Haemophilus influenzae Chlamydophila pneumoniae Respiratory viruses INPATIENT NON ICU S. pneumoniae M. pneumoniae C. Pneumoniae H. influenzae Legionella species Aspiration Respiratory viruses INPATIENT ICU S. pneumoniae Staphylococcus aureus Legionella species Gram negative bacilli H. Influenzae Potentially GNR (IDSA & ATS, 2007 & 2016) 7

8 Definitions of the different types of Pneumonia CAP: patient currently residing in the community with no specific risk factors for resistance HAP: patient residing in the hospital for at least 48 hours and develops a new infiltrate after 48 hours of admission VAP patient developing a pneumonia after at least 48 hours of being ventilated (IDSA & ATS, 2007 & 2017) Antibiotics for CAP Outpatient without comorbidities : Doxycycline Azithromycin Outpatient with comorbidities Moxifloxacin Inpatient Non ICU Ceftriaxone + Azithromycin Moxifloxacin Inpatient ICU Ceftriaxone + Azithromycin Cefepime + Azithromycin Aztreonam + Vancomycin + Azithromycin Worried about QT prolongation Switch azithromycin to doxycycline (IDSA & ATS, 2007 & 2017) Antibiotics for HAP & VAP (IDSA & ATS, 2007 & 2017) 8

9 What about GNR & MRSA When to expect MRSA on the inpatient or outpatient: Outpatients: Recurrent cellulitis Chronic indwelling catheters (PICC s, foley s, ports, etc) Living in a long term care facility with greater than 40% colonization in the home Chronic dialysis Inpatients: Same risk factors as above except, greater than 40% colonization in the ICU When to expect Multi drug resistant (MDR) gram negative rods (GNR s) Receiving chronic (2 or more antibiotics IV or oral in the last 90 days) Living in a long term care facility with known MDR organisms (IDSA & ATS, 2007 & 2017) Who remembers HCAP (Healthcare Associated Pneumonia)? Well, it no longer exists The 2017 IDSA/ATS Guideline update eliminated the term HCAP HCAP previously were defined as: Being exposed to a hospital or receiving broad spectrum abx within the previous 90 days HCAP patients now are treated as CAP patients Is that always appropriate??? NO Lets discuss (IDSA & ATS, 2007 & 2017) Vaccination Influenza updates Pneumococcal Vaccination All persons > 6 months without contraindications Season quadrivalent / trivalent influenza vaccines Live attenuated influenza vaccine not recommended this season due to ineffectiveness against H1N1 during & Pregnant women may receive vaccine. (USDHS, MMWR, 2017) Prevnar 13 / PCV13 Pneumovax 23/PPSV23 Over the age of 65 (both PCV 13 & PPSV23) PCV13 first when possible PCV 13 & PPSV23 > age of 19 Give to High risk concurrent disease/ immunocompromising conditions asplenia CSF leak cochlear implants (ACIP, 2014) 9

10 Smoking Smoking cessation = Goal for all CAP patients who smoke All smokers should be offered smoking cessation education programs, counseling, and treatment, as well as follow up. Oral Care Hospitals and several research studies have found that oral care reduces non ventilator hospital acquired pneumonia (NV HAP) rates by 40% to 60%. References Aujesky, D., Auble, T., Yealy, D., Stone, R., Obrosky, D., Meehan, T., Fine, M. (2005). Prospective comparison of three validated prediction rules for prognosis in community acquired pneumonia. American Journal of Medicine Broulette, J., Y, H., Pyenson, B., Iwasaki, K., &Sato, R. (2013). The incidence rate and economic burden of community acquired pneumonia in a working age population. American Health & Drug Benefits. 6(8) Charles, P., Wolfe, R., Whitby, M., Fine, M., Fuller, A., Stirling, R.,. Grayson,L. (2008). SMART COP: A tool for predicting the need for intensive respiratory or vasopressor support in community acquired pneumonia. Clinical Infectious Disease.47(3): Kalil, A., Metersky, M., Klompas, M., Muscedere, J., Sweeney, D., Palmer, L.,.Brozek, J. (2016). Management of adults with hospital acquired and ventilator associated pneumonia: 2016 clinical practice guidelines by the Infectious Diseases Society of America and the American Thoracic Society. Clinicial Infectious Diseases. 63(5). E61 e111. Retrieved from: Kallet, R. H. (2015). The vexing problem of ventilator associated pneumonia: Observations on pathophysiology, public policy, and clinical science. Respiratory Care, 60(10), doi: /respcare Mandell, L., Wunderink, R., Anzueto, A., Bartlett, J., Campbell, G.,.Whitney, C. (2007). Infectious Diseases Society of America/American Thoracic Society Consensus Guidelines on the management of community acquired pneumonia in adults, Clinical Infectious Diseases, 44(2) Retrieved from: 10

11 References Musher, D. & Thorner, A. (2014). Community acquired pneumonia. New England Journal of Medicine doi /NEJMra Sato,R., Rey, G., Nelson, S. & Pinsky, B. (2013). Community acquired pneumonia episode costs by age and risk in commercially insured US adults aged>50 years. Applied Health Economics and Health Policy. 11(3) Smithuis, R. (2014). Chest X Ray Lung disease. Four pattern approach. Radiology Assistant. Retrieved from: x ray lungdisease.html Tomczyk, S., Bennett, N., Stoecker, C., Gierke, R., Moore, M., Whitney, C., Handler,S. & Philshvilli, T. (2014). Use of 13 Valent pneumococcal conjugate vaccine and 23 valent pneumococcal polysaccharide vaccine among adults aged >65 years: Recommendations of the advisory committee on immunization practices. 63(37) U.S. Department of Health and Human Services, Centers for Disease control and Prevention.(2017). Prevention and control of seasonal influenza with vaccines: Recommendations of the advisory committee on immunization practices United States, Influenza Season. (MMWR Recomm Rep 2016;65[no.RR 5]). Retrieved from Weiss, E., Essaied, W., Adrie, C., Zahar, J., & Timsit, J. (2017). Treatment of severe hospital acquired and ventilator associated pneumonia: a systematic review of inclusion and judgment criteria used in randomized controlled trials. Critical Care, doi: /s Questions 11

Pneumonia Severity Scores:

Pneumonia Severity Scores: Pneumonia Severity Scores: Are they Accurate Predictors of Mortality? JILL McEWEN, MD FRCPC Clinical Professor Department of Emergency Medicine University of British Columbia Vancouver, BC Canada President,

More information

Community-Acquired Pneumonia OBSOLETE 2

Community-Acquired Pneumonia OBSOLETE 2 Community-Acquired Pneumonia OBSOLETE 2 Clinical practice guidelines serve as an educational reference, and do not supersede the clinical judgment of the treating physician with respect to appropriate

More information

Community Acquired & Nosocomial Pneumonias

Community Acquired & Nosocomial Pneumonias Community Acquired & Nosocomial Pneumonias IDSA/ATS 2007 & 2016 Guidelines José Luis González, MD Clinical Assistant Professor of Medicine Outline Intro - Definitions & Diagnosing CAP treatment VAP & HAP

More information

CARE OF THE ADULT PNEUMONIA PATIENT

CARE OF THE ADULT PNEUMONIA PATIENT Care Guideline CARE OF THE ADULT PNEUMONIA PATIENT Target Audience: The target audience for this Care Guideline is all MultiCare providers and staff, including those associated with our clinically integrated

More information

Care Guideline DRAFT for review cycle 08/02/17 CARE OF THE ADULT PNEUMONIA PATIENT

Care Guideline DRAFT for review cycle 08/02/17 CARE OF THE ADULT PNEUMONIA PATIENT Care Guideline DRAFT for review cycle 08/02/17 CARE OF THE ADULT PNEUMONIA PATIENT Target Audience: All MHS employed providers within Primary Care, Urgent Care, and In-Hospital Care. The secondary audience

More information

Pneumonia Community-Acquired Healthcare-Associated

Pneumonia Community-Acquired Healthcare-Associated Pneumonia Community-Acquired Healthcare-Associated Edwin Yu Clin Infect Dis 2007;44(S2):27-72 Am J Respir Crit Care Med 2005; 171:388-416 IDSA / ATS Guidelines Microbiology Principles and Practice of Infectious

More information

Brice Taylor Assistant Professor Division of Pulmonary and Critical Care Medicine

Brice Taylor Assistant Professor Division of Pulmonary and Critical Care Medicine Brice Taylor Assistant Professor Division of Pulmonary and Critical Care Medicine Discuss advances in predicting prognosis Understand dwhat we know (and don t know) about the Microbiology Recognize important

More information

To develop guidelines for the use of appropriate antibiotics for adult patients with CAP and guidance on IV to PO conversion.

To develop guidelines for the use of appropriate antibiotics for adult patients with CAP and guidance on IV to PO conversion. Page 1 of 5 TITLE: COMMUNITY-ACQUIRED PNEUMONIA (CAP) EMPIRIC MANAGEMENT OF ADULT PATIENTS AND IV TO PO CONVERSION GUIDELINES: These guidelines serve to aid clinicians in the diagnostic work-up, assessment

More information

Antimicrobial Stewardship in Community Acquired Pneumonia

Antimicrobial Stewardship in Community Acquired Pneumonia Antimicrobial Stewardship in Community Acquired Pneumonia Medicine Review Course 2018 Dr Lee Tau Hong Consultant Department of Infectious Diseases National Centre for Infectious Diseases Scope 1. Diagnosis

More information

Pneumonia: The Forgotten Killer

Pneumonia: The Forgotten Killer Pneumonia: The Forgotten Killer David Glenn Weismiller, MD, ScM, FAAFP Department of Family and Community Medicine University of Nevada, Las Vegas School of Medicine Disclosure Statement It is the policy

More information

PNEUMONIA. Patient Case: Chief Complaint: I have been short of breath and have been coughing up rust-colored phlegm for the past 3 days.

PNEUMONIA. Patient Case: Chief Complaint: I have been short of breath and have been coughing up rust-colored phlegm for the past 3 days. PNEUMONIA Relevant Guidelines: 2008 IDSA CAP guidelines: http://www.idsociety.org/guidelines/patient_care/idsa_practice_guidelines/infections_by_org an_system/lower/upper_respiratory/community-acquired_pneumonia_(cap)/

More information

Community Acquired Pneumonia. Abdullah Alharbi, MD, FCCP

Community Acquired Pneumonia. Abdullah Alharbi, MD, FCCP Community Acquired Pneumonia Abdullah Alharbi, MD, FCCP A 68 y/ male presented to the ED with SOB and productive coughing for 2 days. Reports poor oral intake since onset due to nausea and intermittent

More information

CAP, HCAP, HAP, VAP. 1. In 1898, William Osler described community-acquired pneumonia as:

CAP, HCAP, HAP, VAP. 1. In 1898, William Osler described community-acquired pneumonia as: 1. In 1898, William Osler described community-acquired pneumonia as: Brad Sharpe, M.D. Professor of Clinical Medicine Department of Medicine UCSF sharpeb@medicine.ucsf.edu I have no relevant financial

More information

Bradley A. Sharpe, M.D. Associate Professor Medicine Department of Medicine UCSF -- William Osler, M.D.

Bradley A. Sharpe, M.D. Associate Professor Medicine Department of Medicine UCSF -- William Osler, M.D. Bradley A. Sharpe, M.D. Associate Professor Medicine Department of Medicine UCSF sharpeb@medicine.ucsf.edu a. An ailment that often leads to suffocation and death. b. A friend of the aged. c. A common

More information

KAISER PERMANENTE OHIO COMMUNITY ACQUIRED PNEUMONIA

KAISER PERMANENTE OHIO COMMUNITY ACQUIRED PNEUMONIA KAISER PERMANENTE OHIO COMMUNITY ACQUIRED PNEUMONIA Methodology: Expert opinion Issue Date: 8-97 Champion: Pulmonary Medicine Most Recent Update: 6-08, 7-10, 7-12 Key Stakeholders: Pulmonary Medicine,

More information

Disclosures. Case 1. Acute Bronchitis. Acute Bronchitis. Community-Acquired Pneumonia and other Respiratory Tract Infections. What do you recommend?

Disclosures. Case 1. Acute Bronchitis. Acute Bronchitis. Community-Acquired Pneumonia and other Respiratory Tract Infections. What do you recommend? Community-Acquired Pneumonia and other Respiratory Tract Infections none Disclosures Joel T. Katz, M.D. Associate Professor of Medicine Division of Infectious Diseases Brigham and Women s Hospital Case

More information

Chapter 22. Pulmonary Infections

Chapter 22. Pulmonary Infections Chapter 22 Pulmonary Infections Objectives State the incidence of pneumonia in the United States and its economic impact. Discuss the current classification scheme for pneumonia and be able to define hospital-acquired

More information

The IDSA/ATS consensus guidelines on the management of CAP in adults

The IDSA/ATS consensus guidelines on the management of CAP in adults The IDSA/ATS consensus guidelines on the management of CAP in adults F. Piffer F. Tardini R. Cosentini U.O. Medicina d'urgenza, Gruppo NIV, Fondazione Ospedale Maggiore Policlinico, Mangiagalli e Regina

More information

Upper...and Lower Respiratory Tract Infections

Upper...and Lower Respiratory Tract Infections Upper...and Lower Respiratory Tract Infections Robin Jump, MD, PhD Cleveland Geriatric Research Education and Clinical Center (GRECC) Louis Stokes Cleveland VA Medical Center Case Western Reserve University

More information

Community-Acquired Pneumonia. Lisa G. Winston, MD University of California, San Francisco San Francisco General Hospital. Nothing to disclose.

Community-Acquired Pneumonia. Lisa G. Winston, MD University of California, San Francisco San Francisco General Hospital. Nothing to disclose. Community-Acquired Pneumonia Lisa G. Winston, MD University of California, San Francisco San Francisco General Hospital Nothing to disclose. Community-Acquired Pneumonia Talk will focus on adults Guideline

More information

Charles Krasner, M.D. University of NV, Reno School of Medicine Sierra NV Veterans Affairs Medical Center

Charles Krasner, M.D. University of NV, Reno School of Medicine Sierra NV Veterans Affairs Medical Center Charles Krasner, M.D. University of NV, Reno School of Medicine Sierra NV Veterans Affairs Medical Center Kathy Peters is a 63 y.o. patient that presents to your urgent care office today with a history

More information

ACIP Recommendations for Pneumococcal 13-valent Conjugate and 23-valent Polysaccharide Vaccine Use among Adults

ACIP Recommendations for Pneumococcal 13-valent Conjugate and 23-valent Polysaccharide Vaccine Use among Adults ACIP Recommendations for Pneumococcal 13-valent Conjugate and 23-valent Polysaccharide Vaccine Use among Adults National Center for Immunization & Respiratory Diseases Respiratory Diseases Branch ACIP

More information

Pneumonia in the Hospitalized

Pneumonia in the Hospitalized Pneumonia in the Hospitalized Patient: Use of Steroids Nicolette Myers, MD Pulmonary/Sleep/Critical Care November 9, 2018 Park Nicollet Clinic Facts About Pneumonia CAP is the 8 th most common cause of

More information

The McMaster at night Pediatric Curriculum

The McMaster at night Pediatric Curriculum The McMaster at night Pediatric Curriculum Community Acquired Pneumonia Based on CPS Practice Point Pneumonia in healthy Canadian children and youth and the British Thoracic Society Guidelines on CAP Objectives

More information

Pneumonia in Older Adults: An Update

Pneumonia in Older Adults: An Update Pneumonia in Older Adults: An Update - 2010 Suzanne F. Bradley, M.D. Professor of Internal Medicine Geriatrics & Infectious Diseases University of Michigan Medical School GRECC - VA Ann Arbor HCS ID Hospitalizations

More information

Pneumonia. Dr. Rami M Adil Al-Hayali Assistant professor in medicine

Pneumonia. Dr. Rami M Adil Al-Hayali Assistant professor in medicine Pneumonia Dr. Rami M Adil Al-Hayali Assistant professor in medicine Definition Pneumonia is an acute respiratory illness caused by an infection of the lung parenchyma, associated with recently developed

More information

Bradley A. Sharpe, M.D. Associate Professor Medicine Department of Medicine UCSF

Bradley A. Sharpe, M.D. Associate Professor Medicine Department of Medicine UCSF Maximizing Care for Community- Acquired Pneumonia Bradley A. Sharpe, M.D. Associate Professor Medicine Department of Medicine UCSF sharpeb@medicine.ucsf.edu 1. In 1898, William Osler described community-acquired

More information

Community Acquired Pneumonia

Community Acquired Pneumonia April 2014 References: 1. Bradley JS, Byington CL, Shah SS, Alverson B, Carter ER, Harrison C, Kaplan SL Mace SE, McCracken Jr. GH, Moor MR, St. Peter SD, Stockwell JA, and Swanson JT. The Management of

More information

UPDATE IN HOSPITAL MEDICINE

UPDATE IN HOSPITAL MEDICINE UPDATE IN HOSPITAL MEDICINE FLORIDA CHAPTER ACP MEETING 2016 Himangi Kaushal, M.D., F.A.C.P. Program Director Memorial Healthcare System Internal Medicine Residency DISCLOSURES None OBJECTIVES Review some

More information

Hospital-acquired Pneumonia

Hospital-acquired Pneumonia Hospital-acquired Pneumonia Hospital-acquired pneumonia (HAP) Pneumonia that occurs at least 2 days after hospital admission. The second most common and the leading cause of death due to hospital-acquired

More information

WORKSHOP. The Multiple Facets of CAP. Community acquired pneumonia (CAP) continues. Jennifer s Situation

WORKSHOP. The Multiple Facets of CAP. Community acquired pneumonia (CAP) continues. Jennifer s Situation Practical Pointers pointers For for Your your Practice practice The Multiple Facets of CAP Dr. George Fox, MD, MSc, FRCPC, FCCP Community acquired pneumonia (CAP) continues to be a significant health burden

More information

Adult CAP. How to approach for diagnosis. Natpatou Sanguanwongse, MD. Bureau of Emerging Infectious Disease July Sunday, July 8, 12

Adult CAP. How to approach for diagnosis. Natpatou Sanguanwongse, MD. Bureau of Emerging Infectious Disease July Sunday, July 8, 12 Adult CAP How to approach for diagnosis Natpatou Sanguanwongse, MD. Bureau of Emerging Infectious Disease July 2012 Community-acquired pneumonia (CAP) one of several disease in which individuals (who have

More information

Severe β-lactam allergy. Alternative (use for mild-moderate β-lactam allergy) therapy

Severe β-lactam allergy. Alternative (use for mild-moderate β-lactam allergy) therapy Recommended Empirical Antibiotic Regimens for MICU Patients Notes: The antibiotic regimens shown are general guidelines and should not replace clinical judgment. Always assess for antibiotic allergies.

More information

Objectives. Pneumonia. Pneumonia. Epidemiology. Prevalence 1/7/2012. Community-Acquired Pneumonia in infants and children

Objectives. Pneumonia. Pneumonia. Epidemiology. Prevalence 1/7/2012. Community-Acquired Pneumonia in infants and children Objectives Community-Acquired in infants and children Review of Clinical Practice Guidelines by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America - 2011 Sabah Charania,

More information

Preventing and Treating Community-Acquired Pneumonia

Preventing and Treating Community-Acquired Pneumonia PL Detail-Document #310618 This PL Detail-Document gives subscribers additional insight related to the Recommendations published in PHARMACIST S LETTER / PRESCRIBER S LETTER June 2015 Preventing and Treating

More information

Getting Smart About: Upper Respiratory Infections

Getting Smart About: Upper Respiratory Infections Getting Smart About: Upper Respiratory Infections Daniel Z. Uslan, MD Assistant Clinical Professor Director, Antimicrobial Stewardship Program UCLA Health System Disclosures None relevant to the topic

More information

The Old Man s Friend (And the Ire of Many an ED QI Director) Objectives. Terminology 10/22/2009

The Old Man s Friend (And the Ire of Many an ED QI Director) Objectives. Terminology 10/22/2009 Pneumonia Management & Chris Fee, MD Assistant Clinical Professor UCSF Department of Emergency Medicine The Old Man s Friend (And the Ire of Many an ED QI Director) 7th leading cause of death in US 915,000

More information

Update on Adult Immunization Strategies: Understanding the Current Recommendations

Update on Adult Immunization Strategies: Understanding the Current Recommendations Update on Adult Immunization Strategies: Understanding the Current Recommendations EDWARD A. DOMINGUEZ, MD, FACP, FIDSA Medical Director, Organ Transplant Infectious Diseases Methodist Dallas Medical Center,

More information

Pneumonia. Definition of pneumonia Infection of the lung parenchyma Usually bacterial

Pneumonia. Definition of pneumonia Infection of the lung parenchyma Usually bacterial Pneumonia Definition of pneumonia Infection of the lung parenchyma Usually bacterial Epidemiology of pneumonia Commonest infectious cause of death in the UK and USA Incidence - 5-11 per 1000 per year Worse

More information

Pneumonia 2017 OMAR PIRZADA

Pneumonia 2017 OMAR PIRZADA Pneumonia 2017 OMAR PIRZADA Pneumonia Pneumonia is common 0.5-1% of adults per year, 5-12% presenting to GP with LRTi 22-42% will be admitted to hospital Symptoms and signs Case 1 26 year old man Sudden

More information

Streptococcus pneumoniae CDC

Streptococcus pneumoniae CDC Streptococcus pneumoniae CDC Pneumococcal Disease Infection caused by the bacteria, Streptococcus pneumoniae» otitis media 20 million office visits (28-55% Strep)» pneumonia 175,000 cases annually» meningitis

More information

WHO estimates, 450 million cases of pneumonia are recorded every year; about. this illness, accounting for 7% of total mortality (2011)

WHO estimates, 450 million cases of pneumonia are recorded every year; about. this illness, accounting for 7% of total mortality (2011) WHO estimates, 450 million cases of pneumonia are recorded every year; about 4 million people die from this illness, accounting for 7% of total mortality (2011) Pneumonias - consultation dr. Gergely Peskó

More information

PNEUMONIA. I. Background 6 th most common cause of death in U.S. Most common cause of infection related mortality

PNEUMONIA. I. Background 6 th most common cause of death in U.S. Most common cause of infection related mortality Page 1 of 8 September 4, 2001 Donald P. Levine, M.D. University Health Center Suite 5C Office: 577-0348 dlevine@intmed.wayne.edu Assigned reading: pages 153-160; 553-563 PNEUMONIA the most widespread and

More information

Catherine Casey S. Jones,

Catherine Casey S. Jones, Community Acquired Pneumonia Catherine Casey S. Jones, PhD, RN, ANP-C, AE-C Catherine Casey S. Jones, PhD, RN, ANP-C, AE-C Texas Pulmonary & Critical Care Consultants, PA & Adjunct Professor at Texas Woman

More information

HEALTHCARE-ASSOCIATED PNEUMONIA: EPIDEMIOLOGY, MICROBIOLOGY & PATHOPHYSIOLOGY

HEALTHCARE-ASSOCIATED PNEUMONIA: EPIDEMIOLOGY, MICROBIOLOGY & PATHOPHYSIOLOGY HEALTHCARE-ASSOCIATED PNEUMONIA: EPIDEMIOLOGY, MICROBIOLOGY & PATHOPHYSIOLOGY David Jay Weber, M.D., M.P.H. Professor of Medicine, Pediatrics, & Epidemiology Associate Chief Medical Officer, UNC Health

More information

Supplementary Online Content

Supplementary Online Content Supplementary Online Content Torres A, Sibila O, Ferrer M, et al. Effect of corticosteroids on treatment failure among hospitalized patients with severe community-acquired pneumonia and high inflammatory

More information

COPD exacerbation. Dr. med. Frank Rassouli

COPD exacerbation. Dr. med. Frank Rassouli Definition according to GOLD report: - «An acute event - characterized by a worsening of the patients respiratory symptoms - that is beyond normal day-to-day variations - and leads to a change in medication»

More information

Streptococcus Pneumoniae

Streptococcus Pneumoniae Streptococcus Pneumoniae (Invasive Pneumococcal Disease) DISEASE REPORTABLE WITHIN 24 HOURS OF DIAGNOSIS Per N.J.A.C. 8:57, healthcare providers and administrators shall report by mail or by electronic

More information

How do we define pneumonia?

How do we define pneumonia? Robert L. Keith MD FCCP Associate Professor of Medicine Division of Pulmonary Sciences & Critical Care Medicine Denver VA Medical Center University of Colorado Denver How do we define pneumonia? Fever

More information

11/19/2012. The spectrum of pulmonary diseases in HIV-infected persons is broad.

11/19/2012. The spectrum of pulmonary diseases in HIV-infected persons is broad. The spectrum of pulmonary diseases in HIV-infected persons is broad. HIV-associated Opportunistic infections Neoplasms Miscellaneous conditions Non HIV-associated Antiretroviral therapy (ART)-associated

More information

Community Acquired Pneumonia in Adults Clinical Practice Guideline Antibiotic Stewardship

Community Acquired Pneumonia in Adults Clinical Practice Guideline Antibiotic Stewardship Community Acquired Pneumonia in Adults Clinical Practice Guideline Antibiotic Stewardship These guidelines are provided to assist physicians and other clinicians in making decisions regarding the care

More information

Critical Care Nursing Theory. Pneumonia. - Pneumonia is an acute infection of the pulmonary parenchyma

Critical Care Nursing Theory. Pneumonia. - Pneumonia is an acute infection of the pulmonary parenchyma - is an acute infection of the pulmonary parenchyma - is a common infection encountered by critical care nurses when it complicates the course of a serious illness or leads to acute respiratory distress.

More information

Infectious Diseases Society of America/American Thoracic Society Consensus Guidelines on the Management of Community-Acquired Pneumonia in Adults

Infectious Diseases Society of America/American Thoracic Society Consensus Guidelines on the Management of Community-Acquired Pneumonia in Adults SUPPLEMENT ARTICLE Infectious Diseases Society of America/American Thoracic Society Consensus Guidelines on the Management of Community-Acquired Pneumonia in Adults Lionel A. Mandell, 1,a Richard G. Wunderink,

More information

Lecture Notes. Chapter 16: Bacterial Pneumonia

Lecture Notes. Chapter 16: Bacterial Pneumonia Lecture Notes Chapter 16: Bacterial Pneumonia Objectives Explain the epidemiology Identify the common causes Explain the pathological changes in the lung Identify clinical features Explain the treatment

More information

Community Acquired Pneumonia-Adults Clinical Practice Guideline MedStar Health

Community Acquired Pneumonia-Adults Clinical Practice Guideline MedStar Health Community Acquired Pneumonia-Adults Clinical Practice Guideline MedStar Health These guidelines are provided to assist physicians and other clinicians in making decisions regarding the care of their patients.

More information

Patient information: Pneumonia in adults (Beyond the Basics)

Patient information: Pneumonia in adults (Beyond the Basics) Page 1 of 8 Official reprint from UpToDate www.uptodate.com 2014 UpToDate Patient information: Pneumonia in adults (Beyond the Basics) Authors Thomas J Marrie, MD Thomas M File, Jr, MD Section Editor John

More information

Community-acquired pneumonia in adults

Community-acquired pneumonia in adults Prim Care Clin Office Pract 30 (2003) 155 171 Community-acquired pneumonia in adults Julio A. Ramirez, MD a,b, * a Department of Medicine, University of Louisville School of Medicine, 512 S. Hancock Street,

More information

Outpatient Management of Patients With Community Acquired Pneumonia Clinical Practice Guideline September 2013

Outpatient Management of Patients With Community Acquired Pneumonia Clinical Practice Guideline September 2013 Clinical Practice Guideline September 2013 General Principles: Community Acquired Pneumonia (CAP), together with influenza, remains the seventh leading cause of death in the United States. According to

More information

Nosocomial Pneumonia. <5 Days: Non-Multidrug-Resistant Bacteria

Nosocomial Pneumonia. <5 Days: Non-Multidrug-Resistant Bacteria Nosocomial Pneumonia Meredith Deutscher, MD Troy Schaffernocker, MD Ohio State University Burden of Hospital-Acquired Pneumonia Second most common nosocomial infection in the U.S. 5-10 episodes per 1000

More information

Microbiology Laboratory Directors, Infection Preventionists, Primary Care Providers, Emergency Department Directors, Infectious Disease Physicians

Microbiology Laboratory Directors, Infection Preventionists, Primary Care Providers, Emergency Department Directors, Infectious Disease Physicians MEMORANDUM DATE: October 1, 2009 TO: FROM: SUBJECT: Microbiology Laboratory Directors, Infection Preventionists, Primary Care Providers, Emergency Department Directors, Infectious Disease Physicians Michael

More information

Community Acquired Pneumonia: Measures to Improve Management and Healthcare Quality

Community Acquired Pneumonia: Measures to Improve Management and Healthcare Quality Community Acquired Pneumonia: Measures to Improve Management and Healthcare Quality Gonzalo Bearman MD, MPH Assistant Professor of Internal Medicine Divisions of Quality Health Care & Infectious Diseases

More information

POLICY FOR TREATMENT OF LOWER RESPIRATORY TRACT INFECTIONS

POLICY FOR TREATMENT OF LOWER RESPIRATORY TRACT INFECTIONS POLICY F TREATMENT OF LOWER RESPIRATY TRACT INFECTIONS Written by: Dr M Milupi, Consultant Microbiologist Date: June 2018 Approved by: The Drugs & Therapeutics Committee Date: July 2018 Implementation

More information

MAJOR ARTICLE. (See the editorial commentary by Mandell on pages 386 8)

MAJOR ARTICLE. (See the editorial commentary by Mandell on pages 386 8) MAJOR ARTICLE Severe Community-Acquired Pneumonia: Validation of the Infectious Diseases Society of America/ American Thoracic Society Guidelines to Predict an Intensive Care Unit Admission Adamantia Liapikou,

More information

Haemophilus influenzae

Haemophilus influenzae Haemophilus influenzae type b Severe bacterial infection, particularly among infants During late 19th century believed to cause influenza Immunology and microbiology clarified in 1930s Haemophilus influenzae

More information

Pneumococcal Disease and Pneumococcal Vaccines

Pneumococcal Disease and Pneumococcal Vaccines Pneumococcal Disease and Epidemiology and Prevention of - Preventable Diseases Note to presenters: Images of vaccine-preventable diseases are available from the Immunization Action Coalition website at

More information

PNEUMONIA IN CHILDREN. IAP UG Teaching slides

PNEUMONIA IN CHILDREN. IAP UG Teaching slides PNEUMONIA IN CHILDREN 1 INTRODUCTION 156 million new episodes / yr. worldwide 151 million episodes developing world 95% in developing countries 19% of all deaths in children

More information

Michael S. Niederman, M.D. Clinical Director Pulmonary and Critical Care Medicine New York Presbyterian Hospital Weill Cornell Medical Center

Michael S. Niederman, M.D. Clinical Director Pulmonary and Critical Care Medicine New York Presbyterian Hospital Weill Cornell Medical Center CA-MRSA Pneumonia Michael S. Niederman, M.D. Clinical Director Pulmonary and Critical Care Medicine New York Presbyterian Hospital Weill Cornell Medical Center Professor of Clinical Medicine Weill Cornell

More information

ESCMID Online Lecture Library. by author

ESCMID Online Lecture Library. by author INFLUENZA IN CHILDREN Cristian Launes Infectious Diseases Unit. Department of Paediatrics. Hospital Sant Joan de Déu (Universitat de Barcelona) Innovation in Severe Acute Respiratory Infections (SARI),

More information

Influenza-Associated Pediatric Deaths Case Report Form

Influenza-Associated Pediatric Deaths Case Report Form STATE USE ONLY DO NOT SEND INFORMATION IN THIS SECTION TO CDC Form approved OMB No. 0920-0007 Last Name: First Name: County: Address: City: State, Zip: Patient Demographics 1. State: 2. County: 3. State

More information

Guidelines/Guidance/CAP/ Hospitalized Child. PHM Boot Camp 2014 Jay Tureen, MD June 19, 2014

Guidelines/Guidance/CAP/ Hospitalized Child. PHM Boot Camp 2014 Jay Tureen, MD June 19, 2014 Guidelines/Guidance/CAP/ Hospitalized Child PHM Boot Camp 2014 Jay Tureen, MD June 19, 2014 CAP in Children: Epi Greatest cause of death in children worldwide Estimated > 2 M deaths in children In developed

More information

Supplementary appendix

Supplementary appendix Supplementary appendix This appendix formed part of the original submission and has been peer reviewed. We post it as supplied by the authors. Supplement to: Blum CA, Nigro N, Briel M, et al. Adjunct prednisone

More information

Guidelines 2017 for the management of hospitalacquired pneumonia (HAP) and. ventilator-associated. pneumonia (VAP)

Guidelines 2017 for the management of hospitalacquired pneumonia (HAP) and. ventilator-associated. pneumonia (VAP) Guidelines 2017 for the management of hospitalacquired pneumonia (HAP) and ventilator-associated Modifiez le style des sous-titres du masque pneumonia (VAP) Filip Moerman Présentation pour les soins int

More information

Sepsis is an important issue. Clinician s decision-making capability. Guideline recommendations

Sepsis is an important issue. Clinician s decision-making capability. Guideline recommendations Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock: 2012 Clinicians decision-making capability Guideline recommendations Sepsis is an important issue 8.7%

More information

To Study The Cinico-Radiological Features And Associated Co-Morbid Conditions

To Study The Cinico-Radiological Features And Associated Co-Morbid Conditions IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-issn: 2279-0853, p-issn: 2279-0861.Volume 17, Issue 7 Ver. 16 (July. 2018), PP 58-62 www.iosrjournals.org To study the clinico-radiological features

More information

Acute Respiratory Infection. Dr Anthony Gibson

Acute Respiratory Infection. Dr Anthony Gibson Acute Respiratory Infection Dr Anthony Gibson Range of Conditions Upper tract Common Cold coryza Sore Throat- Pharyngitis Sinusitis Epiglottitis Range of Conditions Lower Acute Bronchitis Acute Exacerbation

More information

MCH-Immunization Conference. September 2012

MCH-Immunization Conference. September 2012 MCH-Immunization Conference September 2012 Rosalyn Singleton MD Arctic Investigations Program-CDC Alaska Native Tribal Health Consortium, Anchorage, AK DISCLAIMER: The results and conclusions presented

More information

MANAGEMENT OF COMMUNITY ACQUIRED PNEUMONIA IN THE ASIA PACIFIC REGION

MANAGEMENT OF COMMUNITY ACQUIRED PNEUMONIA IN THE ASIA PACIFIC REGION MANAGEMENT OF COMMUNITY ACQUIRED PNEUMONIA IN THE ASIA PACIFIC REGION Chong-Kin LIAM Department of Medicine Faculty of Medicine University of Malaya Kuala Lumpur liamck@ummc.edu.my COMMUNITY ACQUIRED PNEUMONIA

More information

Epidemiology and Etiology of Community-Acquired Pneumonia 761 Lionel A. Mandell

Epidemiology and Etiology of Community-Acquired Pneumonia 761 Lionel A. Mandell LOWER RESPIRATORY TRACT INFECTIONS Preface Thomas M. File, Jr xiii Community-Acquired Pneumonia: Pathophysiology and Host Factors with Focus on Possible New Approaches to Management of Lower Respiratory

More information

These slides are the property of the presenter. Do not duplicate without express written consent.

These slides are the property of the presenter. Do not duplicate without express written consent. Cancer Survivorship Protecting Against Vaccine Preventable Diseases Heidi Loynes BSN, RN Immunization Nurse Educator Michigan Department of health and Human Services (MDHHS) loynesh@michigan.gov Are Vaccine-Preventable

More information

Respiratory Infections

Respiratory Infections Respiratory Infections NISHANT PRASAD, MD THE DR. JAMES J. RAHAL, JR. DIVISION OF INFECTIOUS DISEASES NEWYORK-PRESBYTERIAN QUEENS Disclosures Stockholder: Contrafect Corp., Bristol-Myers Squibb Co Research

More information

Sepsi: nuove definizioni, approccio diagnostico e terapia

Sepsi: nuove definizioni, approccio diagnostico e terapia GIORNATA MONDIALE DELLA SEPSI DIAGNOSI E GESTIONE CLINICA DELLA SEPSI Giovedì, 13 settembre 2018 Sepsi: nuove definizioni, approccio diagnostico e terapia Nicola Petrosillo Società Italiana Terapia Antiinfettiva

More information

HEALTHCARE-ASSOCIATED PNEUMONIA: DIAGNOSIS, TREATMENT & PREVENTION

HEALTHCARE-ASSOCIATED PNEUMONIA: DIAGNOSIS, TREATMENT & PREVENTION HEALTHCARE-ASSOCIATED PNEUMONIA: DIAGNOSIS, TREATMENT & PREVENTION David Jay Weber, M.D., M.P.H. Professor of Medicine, Pediatrics, & Epidemiology Associate Chief Medical Officer, UNC Health Care Medical

More information

Clinical Practice Management Guideline for Ventilator-Associated Pneumonia: Diagnosis, Treatment & Prevention

Clinical Practice Management Guideline for Ventilator-Associated Pneumonia: Diagnosis, Treatment & Prevention Clinical for Ventilator-Associated Pneumonia: Diagnosis, Treatment & Prevention Background Ventilator-associated pneumonia (VAP), a pneumonia that develops 48hrs after initiation of mechanical ventilation,

More information

Neutropenic Fever. CID 2011; 52 (4):e56-e93

Neutropenic Fever.  CID 2011; 52 (4):e56-e93 Neutropenic Fever www.idsociety.org CID 2011; 52 (4):e56-e93 Definitions Fever: Single oral temperature of 101 F (38.3 C) Temperature 100.4 F (38.0 C) over 1 hour Neutropenia: ANC < 500 cells/mm 3 Expected

More information

Accurate Diagnosis Of Postoperative Pneumonia Requires Objective Data

Accurate Diagnosis Of Postoperative Pneumonia Requires Objective Data Accurate Diagnosis Of Postoperative Pneumonia Requires Objective Data David Ebler, MD David Skarupa, MD Andrew J. Kerwin, MD, FACS Jhun de Villa, MD Michael S. Nussbaum, MD, FACS J.J. Tepas III, MD, FACS

More information

Session: How to manage and prevent the different faces of pneumonia Severe CAP

Session: How to manage and prevent the different faces of pneumonia Severe CAP Athens 19, 20 November 2015 Garyfallia Poulakou Consultant, Infectious Diseases 4 th Department of Internal Medicine, Attikon University Hospital of Athens Session: How to manage and prevent the different

More information

Supplementary Appendix

Supplementary Appendix Supplementary Appendix This appendix has been provided by the authors to give readers additional information about their work. Supplement to: Jain S, Kamimoto L, Bramley AM, et al. Hospitalized patients

More information

Flu & Pneumonia Provider Toolkit

Flu & Pneumonia Provider Toolkit Flu & Pneumonia Provider Toolkit 2018-2019 ILQI1809.1 Molina Healthcare and Providers Work Together to Protect Members from Flu & Pneumonia Molina Healthcare of Illinois (Molina) is continuing efforts

More information

Pneumonia and influenza combined are the fifth leading

Pneumonia and influenza combined are the fifth leading Community-Acquired Pneumonia in Older Veterans: Does the Pneumonia Prognosis Index Help? Lona Mody, MD,* Rongjun Sun, PhD, and Suzanne Bradley, MD* OBJECTIVES: Mortality rates from pneumonia increase steadily

More information

Impact of pre-hospital antibiotic use on community-acquired pneumonia

Impact of pre-hospital antibiotic use on community-acquired pneumonia ORIGINAL ARTICLE INFECTIOUS DISEASE Impact of antibiotic use on community-acquired pneumonia A. F. Simonetti 1, D. Viasus 1,2, C. Garcia-Vidal 1,2, S. Grillo 1, L. Molero 1, J. Dorca 3,4 and J. Carratala

More information

Update on Adult Immunization Strategies: Understanding the Current Recommendations

Update on Adult Immunization Strategies: Understanding the Current Recommendations Sunday CME Breakfast Update on Adult Immunization Strategies: Understanding the Current Recommendations Edward Dominguez, MD Medical Director, Organ Transplant Infectious Diseases Methodist Dallas Medical

More information

Community acquired pneumonia

Community acquired pneumonia Community acquired pneumonia definition Symptoms of an acute LRTI New focal signs on chest examination At least one systemic feature New radiographic shadow Defination{Crofton} IT IS A SYNDROME CAUSED

More information

Pneumococcal pneumonia

Pneumococcal pneumonia Pneumococcal pneumonia Wei Shen Lim Consultant Respiratory Physician & Honorary Professor of Medicine Nottingham University Hospitals NHS Trust University of Nottingham Declarations of interest Unrestricted

More information

PULMONARY EMERGENCIES

PULMONARY EMERGENCIES EMERGENCIES I. Pneumonia A. Bacterial Pneumonia (most common cause of a focal infiltrate) 1. Epidemiology a. Accounts for up to 10% of hospital admissions in the U.S. b. Most pneumonias are the result

More information

Recommendations for Using Pneumococcal Vaccines among Adults

Recommendations for Using Pneumococcal Vaccines among Adults Recommendations for Using Pneumococcal Vaccines among Adults AI Collaborative Webinar July 2017 Tamara Pilishvili Respiratory Diseases Branch, CDC National Center for Immunization & Respiratory Diseases

More information

Pneumonia (PN) Frequently Asked Questions (FAQs) 2Q09 and 3Q09. Adult Smoking History. Another Suspected Source of Infection

Pneumonia (PN) Frequently Asked Questions (FAQs) 2Q09 and 3Q09. Adult Smoking History. Another Suspected Source of Infection Pneumonia (PN) Frequently Asked Questions (FAQs) Adult Smoking History The nurse wrote patient smoker for 15 years but does not indicate when or if he quit. The physician in the H&P wrote "The patient

More information

Chapter 10 Respiratory System J00-J99. Presented by: Jesicca Andrews

Chapter 10 Respiratory System J00-J99. Presented by: Jesicca Andrews Chapter 10 Respiratory System J00-J99 Presented by: Jesicca Andrews 1 Respiratory System 2 Respiratory Infections A respiratory infection cannot be assumed from a laboratory report alone; physician concurrence

More information

Diagnosis of Ventilator- Associated Pneumonia: Where are we now?

Diagnosis of Ventilator- Associated Pneumonia: Where are we now? Diagnosis of Ventilator- Associated Pneumonia: Where are we now? Gary French Guy s & St. Thomas Hospital & King s College, London BSAC Guideline 2008 Masterton R, Galloway A, French G, Street M, Armstrong

More information

Influenza-Associated Pediatric Mortality Case Report Form Form Approved OMB No

Influenza-Associated Pediatric Mortality Case Report Form Form Approved OMB No Influenza-Associated Pediatric Mortality Case Report Form Form Approved OMB No. 0920-0004 STATE USE ONLY DO NOT SEND INFORMATION IN THIS SECTION TO CDC Last Name: First Name: County: Address: City: State,

More information

A Comparative Study of Community-Acquired Pneumonia Patients Admitted to the Ward and the ICU*

A Comparative Study of Community-Acquired Pneumonia Patients Admitted to the Ward and the ICU* CHEST Original Research A Comparative Study of Community-Acquired Pneumonia Patients Admitted to the Ward and the ICU* Marcos I. Restrepo, MD, MSc, FCCP; Eric M. Mortensen, MD, MSc; Jose A. Velez, MD;

More information