番茄花园-Pneumonia

The second or third generation cephalosporin plus A macrolide
A betalactam/betalactamase inhibitor.
A newer fluoroquinolone
Vancomycin
Empiric therapy (5)
Pneumonia
Etiology
There are two factors involved in the formation of pneumonia , including pathogens and host defenses.
Classification
Classification of anatomy Classification of pathogen Classification of acquired environment
Pathogen identification
Sputum: More than 25 white blood cells (WBCs) and less than 10 epithel ETA, PSB, LA Blood culture or pleural effusion culture Serologic testing (immunological testing) Molecular Techniques
Viral pneumonia
Viral pneumonia may be caused by adenoviruses, respiratory syncytial virus, influenza, cytomegalovirus, herpes simplex
Pneumonia caused by other pathogen
Empiric therapy (1)
Outpatient<60 years old and no comorbid diseases
Common pathogens: S pneumoniaes, M pneumoniae, C pneumoniae, H influenzae and viruses
Common pathogen:S pneumoniae, H influenzae, polymicrobial, Anaerobes, S aureus, C pneumoniae, Gramnegative bacilli.
The second or third generation cephalosporin plus A macrolide
Common pathogens: S pneumoniae(drugresistant), M pneumoniae, C pneumoniae, H pneumoniae, H influenzae, Viruses, Gram-negative bacilli and S aureus
A fluoroquinolone
The principal of therapy
Select antibiotics According to guideline
Therapy
The therapy should always follow confirmation of the diagnosis of pneumonia and should always be accompanied by a diligent effort to identify an etiologic agent. Empiric therapy,(4-8h) Combined empiric therapy to target therapy
the lobe only, segmental or of alveoli contiguous to bronchi (bronchopneumonia).
3. Interstitial（间质性）
Lobar pneumonia
Lobular pneumonia
Interstitial pneumonia
Clinical manifestation
The onset is accute Respiratory symptoms Extrapulmonary symptoms
signs
Consolidation signs Moist rales Respiratory rate or heart rate
A new generation macrolide
A beta-lactam: the first generation cephlosporin
A fluoroquinolone
Empiric therapy (2)
Outpatient>65 years old or having comorbid diseases or antibiotic therapy within last 3 months
A betalactam/betalactamase inhibitor.
A newer fluoroquinolone
Empiric therapy (4)
Inpatient severely ill
Common pathogens:S pneumoniae, Gramnegative bacilli, M pneumoniae, S aureus and viruses
Ⅰ.Classification by pathogen
Pathogen classification is the most useful to treat the patients by choosing effective antimicrobial agents
Bacterial pneumonia
CAP (社区获得性肺炎）
CAP refers to pneumonia acquired outside of hospitals or extended-care facilities . Streptococcus pneumoniae remains the most commonly identified pathogen. Other pathogens include Haemophilus influenzae, mycoplasma pneumoniae, Chlamydophilia pneumoniae, Moraxella catarrhalis and ects. Drug resistance streptococcus pneumoniae(DRSP)
(3) Anaerobic bacteria
Atypical pneumonia
Including Legionnaies pneumonia ,
Mycoplasmal pneumonia ,chlamydia pneumonia.
Fungal pneumonia
Fungal pneumonia is commonly caused by candida(念珠菌) and aspergilosis(曲菌). pneumocystis jiroveci（肺孢子虫）
(1) Aerobic Gram-positive bacteria,such as streptococcus pneumoniae, staphylococcus aureus, Group A hemolytic streptococci
(2) Aerobic Gram-negative bacteria, such as klebsiella pneumoniae, Hemophilus influenzae, Escherichia coli
The diagnostic standard of sever pneumonia
Altered mental status Pa02<60mmHg. PaO2/FiO2<300, needing MV Respiratory rate>30/min Blood pressure<90/60mmHg Chest X-ray shows that bilateral infiltration, multilobar infiltration and the infiltrations enlarge more than 50% within 48h. Renal function: U<20ml/h, and <80ml/4h
X-ray examination Pathogen identification
Differentiation
Pulmonary tuberculosis Lung cancer Acute lung abecess Pulmonary embolism Noninfectious pulmonary infiltration
Classification by acquired environment
Community acquired pneumonia，CAP （社区获得性肺炎） Hospital acquired pneumonia，HAP ，NP （医院获得性肺炎） Nursing home acquired pneumonia,NHAP (护理院获得性肺炎） Immunocompromised host pneumonia,(ICAP) (免疫宿主低下肺炎）
It is important to evaluate the severity degree of pneumonia
The critical management decision is whether the patient will require hospital admission. It is based on patient characteristics, comorbid illness, physical examinations, and basic laboratory findings.
Laboratory examination
WBC X-ray features
Diagnosis
Clinical diagnosis Pathogen diagnosis Evaluate the severity degree of pneumonia
Therapy
Antiinfectious therapy(Combined empiric therapy to target therapy) Supportive therapy
Diagnosis（诊断步骤）
Give a definite diagnosis of pneumonia To evaluate the degree of the pneumonia To definite the pathogen of the pneumonia
Diagnosis
History and physical examination(5W)
Patients in ICU without Pneudomonas aeruginosa infection
Rickettsias (a fever rickettsia), (立克次体）
parasites(寄生虫) protozoa（原虫）
Ⅱ.Classification by anatomy
1. Lobar（大叶性）: Involvement of an entire
lobe
2. Lobular（小叶性）: Involvement of parts of
A beta-lactam / betalactamase inhibitor
The second generation cephalosporin
or combination of a macrolide
Empiric therapy (3)
Inpatient : Not severely ill.