Bacterial Pneumonia Sung Chul Hwang, M.D. Dept. of Pulmonary and Critical Care Medicine Ajou University School of Medicine.

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Presentation transcript:

Bacterial Pneumonia Sung Chul Hwang, M.D. Dept. of Pulmonary and Critical Care Medicine Ajou University School of Medicine

Epidemiology 6th leading cause of death in U.S. Number one Among the infectious diseases 4 million patients annually in US Incidence 12/1,000/year Mortality in OPD patients 1-5 %, but Inpatients 25%, ICU 50-60%

Definition Pneumonia is the inflammation of lower respiratory tracts including alveoli, interstitial tissues, and broncioles by the microorganisms, chemical irritations or by an immunological process

Classifications & Terminology Community Acquired Pneumonia Nosocomial Pneumonia Ventilator Associated Pneumionia Mild, moderate, severe Bacterial, viral, fungal, parasitic Primary vs. Secondary Immune compromised vs. Normal immunity Lobar vs interstitial Typical vs. Atypical

Severe Community Acquired Pneumonia Respiratory rate > 30/min PaO2/FiO2 ratio < 250mmHg Need for Mechanical Ventilation Diffuse bilateral involvement or multiple lobes, incresing infiltration > 50% within 48 hours B.P. < 90systolic or 60 mmHg diastolic Need for vasopressors Renal failure

Mycoplasma Pneumonia

Streptococcal Pneumonia

Streptococcus pneumoniae Gram + Diplococci

Streptococcal Pneumonia

Staphylococcus aureus BAL Fluid

Staphylococcal Pneumonia Pneumatocele

Staphylococcal Pneumonia

Osler’s Node

Pseudomonas Pneumonia

Ecthyma gangrenosum

Immunofluorescent Ab Test RSV Antigen Detection

Legionella Pneumonia

Legionella pneumophila by Silver impregnation Stain

Pneumonia in COPD

CMV Inclusion in BAL

Sputum Gram Stain

Treatment of CAP <60yrs/OPD/no Comorbid conditions Pathogens : S. pneumoniae, Mycoplasma& Chlamydia pneumoniae, H. indfluenzae, RSV, Legionella, S. aureus Treatment : 2 nd Generation Cephalosporin + Macrolide or Quinolone monotherapy

Treatment of CAP >60yrs/OPD/with Comorbid conditions Pathogens : S. pneumoniae, RSV, H. indfluenzae, Gram (-) rod, S. aureus, Morexella catarrhalis, Legionella spp. Treatment : 2 nd Generation Cephalosporin + TMX/SFX, or beta lactam/betalactam inhibitor + Macrolide

Treatment of Severe CAP Pathogens : S. pneumoniae, Legionella spp. Gram (-) rod, Mycoplasma,H. indfluenzae,S. aureus Treatment : 3 rd Generation Cephalosporin with anti- Pseudomonal activity or + other anti Pseudomonal agent (Imipenem/quinolone) + Macrolide

Aspiration Pneumonia

Lipoid Pneumonia