Community Acquired Pneumonia (CAP) A
Grade Exam 2024|Questions with Complete
Solutions
Sputum Gram Stain/Culture
Community-Acquired Pneumonia - Ans • Good vs bad specimen - good specimen:
- < 10 epithelial cells/LPF
- > 25 WBCs/LPF
• Often contaminated with normal mouth flora
• Controversy regarding usefulness
• May help identify infecting organism
• Culture only performed if gram stain reveals a
good specimen
• Results should be interpreted by
correlating clinical observations and the
predominant pathogen on gram stain
Diagnostic Tests
Community-Acquired Pneumonia - Ans • 2007 CAP Guidelines state:
- "In addition to a constellation of suggestive clinical features, a demonstrable
infiltrate by CXR or other imaging technique, with or without supporting
,microbiological data, is required for the diagnosis of pneumonia"
- "Patients with CAP should be investigated for the specific pathogens that would
significantly alter empirical
management decisions, when the presence of such pathogens is suspected on the
basis of clinical and epidemiologic clues"
Diagnostic Testing
Community-Acquired Pneumonia - Ans • Recommendations for diagnostic testing
remain controversial (Table 5 in guidelines)
• For outpatients
- Routine diagnostic tests are optional
• Hospitalized patients
- Pretrtmt blood and expectorated sputum samples should be obtained in selected pts
• Severe CAP
- Pretrtmt blood cx, urinary antigen tests for Legionella/S. pneumoniae, sputum
Goals of Treatment
Community-Acquired Pneumonia - Ans • Eradicate the causative pathogen
• Resolve signs/symptoms
• Minimize complications
• Minimize hospitalization
• Minimize adverse effects/drug interactions
• Prevent re-infection
Challenges to Treatment
Community-Acquired Pneumonia - Ans • Difficulty in determining pathogen
- Empiric therapy
, - Bacterial vs atypical vs viral
• Resistant pathogens
Antimicrobial Therapy
Community-Acquired Pneumonia - Ans • Decision dependent upon:
- Patient location
• Outpatient
• Inpatient - non-ICU
• Inpatient - ICU
- Risk factors for drug resistant S. pneumoniae
- Potential for Pseudomonas
- Potential for CA-MRSA
- Recent antibiotic use
Antimicrobial Therapy Outpt
Community-Acquired Pneumonia - Ans • Outpatients:
- Previously healthy and no use of abx w/in previous 3 months
** Macrolide or doxycycline
- In areas with high rates (> 25%) of macrolideresistant S. pneumoniae consider use
of alternative agents
-Mycoplasma infection most common < 50
yrs/ healthy
- S. pneumoniae more common in older patients
• Comorbidities
Grade Exam 2024|Questions with Complete
Solutions
Sputum Gram Stain/Culture
Community-Acquired Pneumonia - Ans • Good vs bad specimen - good specimen:
- < 10 epithelial cells/LPF
- > 25 WBCs/LPF
• Often contaminated with normal mouth flora
• Controversy regarding usefulness
• May help identify infecting organism
• Culture only performed if gram stain reveals a
good specimen
• Results should be interpreted by
correlating clinical observations and the
predominant pathogen on gram stain
Diagnostic Tests
Community-Acquired Pneumonia - Ans • 2007 CAP Guidelines state:
- "In addition to a constellation of suggestive clinical features, a demonstrable
infiltrate by CXR or other imaging technique, with or without supporting
,microbiological data, is required for the diagnosis of pneumonia"
- "Patients with CAP should be investigated for the specific pathogens that would
significantly alter empirical
management decisions, when the presence of such pathogens is suspected on the
basis of clinical and epidemiologic clues"
Diagnostic Testing
Community-Acquired Pneumonia - Ans • Recommendations for diagnostic testing
remain controversial (Table 5 in guidelines)
• For outpatients
- Routine diagnostic tests are optional
• Hospitalized patients
- Pretrtmt blood and expectorated sputum samples should be obtained in selected pts
• Severe CAP
- Pretrtmt blood cx, urinary antigen tests for Legionella/S. pneumoniae, sputum
Goals of Treatment
Community-Acquired Pneumonia - Ans • Eradicate the causative pathogen
• Resolve signs/symptoms
• Minimize complications
• Minimize hospitalization
• Minimize adverse effects/drug interactions
• Prevent re-infection
Challenges to Treatment
Community-Acquired Pneumonia - Ans • Difficulty in determining pathogen
- Empiric therapy
, - Bacterial vs atypical vs viral
• Resistant pathogens
Antimicrobial Therapy
Community-Acquired Pneumonia - Ans • Decision dependent upon:
- Patient location
• Outpatient
• Inpatient - non-ICU
• Inpatient - ICU
- Risk factors for drug resistant S. pneumoniae
- Potential for Pseudomonas
- Potential for CA-MRSA
- Recent antibiotic use
Antimicrobial Therapy Outpt
Community-Acquired Pneumonia - Ans • Outpatients:
- Previously healthy and no use of abx w/in previous 3 months
** Macrolide or doxycycline
- In areas with high rates (> 25%) of macrolideresistant S. pneumoniae consider use
of alternative agents
-Mycoplasma infection most common < 50
yrs/ healthy
- S. pneumoniae more common in older patients
• Comorbidities
