1. Pneumonia
Steven Podnos MD

2. Etiology
• Aspiration primary cause for bacterial
pneumonia
• Aerosol transmission important for
viral/atypical/TB
• Abnormal host response may be important in
immuncompromised patients-
neutropenia, PCP
• Important to know oral flora

3. Risk Factors
• Community Acquired “Healthy”
• Community Acquired “Sick”
• Health Care Associated

4. Clinical Features
• History
• PE-
RR,Fever, Hypoxemia, Hypercapnia, Shock, Che
st Pain
• Sputum
• CXR
• WBC, Na
• ABG

5. Community Acquired Pneumonia
• Etiology-Viral/Atypical/Bacteria-
Pneumococcus, H. Flu
• Clinical Presentation guides both decision to
admit and initial Rx
• Discuss Diagnostic Approach

6. Criteria for clinical stability.
Mandell L A et al. Clin Infect Dis. 2007;44:S27-S72
© 2007 by the Infectious Diseases Society of America

7. Clinical indications for more extensive diagnostic testing.
Mandell L A et al. Clin Infect Dis. 2007;44:S27-S72
© 2007 by the Infectious Diseases Society of America

8. Therapy
• Timing of first dose important
• Length of Rx variable
• Oral vs. IV considerations

9. Recommended empirical antibiotics for community-acquired pneumonia.
Mandell L A et al. Clin Infect Dis. 2007;44:S27-S72
© 2007 by the Infectious Diseases Society of America

10. Health Care Associated Pneumonia
• Increased risk of aspiration if intubated
• Ventilator Care Bundles
• Other attempts to prevent
• Etiology, MDR, Gram neg, Staph and MRSA but
can also have CAP type organisms

12. Potential Pathogens Combination Antibiotic Therapy*
Pathogens listed in Table 3 and Antipseudomonal cephalosporin
MDR pathogens (cefepime, ceftazidime)
Pseudomonas aeruginosa or
Klebsiella pneumoniae (ESBL+) Antipseudomonal carbepenem
Acinetobacter species (imipenem or meropenem)
or
ß-Lactam/ß-lactamase inhibitor
(piperacillin–tazobactam)
plus
Antipseudomonal fluoroquinolone
(ciprofloxacin or levofloxacin)
or
Aminoglycoside
(amikacin, gentamicin, or tobramycin)
plus
Methicillin-resistant Staphylococcus
aureus (MRSA) Linezolid or vancomycin
Legionella pneumophila

13. Non Antibiotic Rx
• Oxygen
• ARDS net ventilation vs BiPAP
• IVF
• Resp RX

14. Non responders