Multiprofessional Critical Care Review: Adult 2024 (MCCRCA24ON)-5: Community-Acquired Pneumonia: Cases You Should Know (Robert A. Balk, MD, MCCM)

Video Transcription

Video Summary

This video discusses community-acquired pneumonia (CAP), its definitions, risk factors, common pathogens, and treatment guidelines. CAP is the second most common cause of death worldwide and the most common cause of death from infection in developed countries. It is associated with increased mortality, development of acute respiratory failure and ARDS, and ventilatory support. The clinical manifestations include cough, purulent sputum, chest pain, fever, and dyspnea. Diagnosis is confirmed through abnormal chest x-ray findings and isolation of pathogens through cultures or other means. Streptococcus pneumoniae is the most common bacterial pathogen, while atypical pathogens are also commonly encountered. The bacteriology of severe CAP has changed over the years, with increased prevalence of Legionella and atypical pathogens. Various scoring systems are used to assess the severity of CAP, including the CURB-65 and PSI scores. Empirical antibiotic treatment for severe CAP typically includes a beta-lactam antibiotic plus either azithromycin or a respiratory fluoroquinolone. Treatment should be guided by local antibiogram and the presence of risk factors for specific pathogens, such as MRSA or Pseudomonas aeruginosa. Corticosteroids may be beneficial in severe CAP with refractory shock. Steroid treatment should be avoided in non-severe CAP. Early initiation of appropriate antibiotic therapy is crucial, and treatment should be given for a duration of five to seven days based on clinical improvement. Preventive measures such as influenza and pneumococcal vaccinations are important in reducing the risk of CAP.

Keywords

community-acquired pneumonia

CAP

definitions

risk factors

common pathogens

treatment guidelines

bacterial pathogens

antibiotic therapy

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