Community acquired pneumonia & Hospital Acquired Pneumonia

Community acquired pneumonia & Hospital Acquired Pneumonia What qualifies as CAP? -ambulatory/outpatients (outside of a healthcare setting) -patients who are NOT residents of nursing homes or other long term facilities -diagnosed if present within 48hrs of a hospital admission What percent of cases is an unidentifiable cause of CAP? 40-60% What bacteria accounts for 2/3 of CAP isolates? S pneumoniae What is the most common viral infection that progresses into CAP PNA? Influenza Sometiems causes compromise to lead to secondary bacterial infection In 5% of CAP cases, what do providers find? 2+ pathogens What do prevelance of pathogens depend on? Geography, vaccination rates, season, and host risk factors Other bacteria, atypical bacteria, viruses, and fungi based on epidemiologic risk factors CAP risk factors 1. Advanced age 2. Smoking 3. Alcoholism 4. Comorbidities 5. Aspiration 6. Immunosuppression Why does smoking increase risk of CAP? Inhibits mucociliary apparatus What comorbidities increase risk of CAP? Lung cancer COPD Bronchiectasis Asthma Who is at highest risk to aspirate and cause CAP? 1. Comatose patients, stroke patients 2. Chronic gingivitis or periodontitis 3. Alcohol and drug intoxication Immunosuppression pts (HIV/AIDS) what kind of CAP do they get? 1. HIV AIDS: pneumocystisis Jiroveci**** -yeast like fungal organism Previously called pneumocystisis carinii or PCP Nosocomial definition Originating in a hospital Nosocomial pneumonia guidelines 1. Begins MORE than 48hrs after admission to hospital or other healthcare facility 2. Excludes any infection present within the first 48hrs of admission 3. Second most common and morbid hospital acquired infection