Bacterial Pneumonia

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Bacterial Pneumonia

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

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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

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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

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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

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Severe Community Acquired Pneumonia

• Respiratory rate gt 30/min
• PaO2/FiO2 ratio lt 250mmHg
• Need for Mechanical Ventilation
• Diffuse bilateral involvement or multiple lobes,
  incresing infiltration gt 50 within 48 hours
• B.P. lt 90systolic or 60 mmHg diastolic
• Need for vasopressors
• Renal failure

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Mycoplasma Pneumonia
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Mycoplasma Pneumonia
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Mycoplasma Pneumonia
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Streptococcal Pneumonia
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Streptococcus pneumoniae
Gram Diplococci
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Streptococcal Pneumonia
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Streptococcal Pneumonia
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Staphylococcus aureus
BAL Fluid
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Staphylococcal Pneumonia
Pneumatocele
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Staphylococcal Pneumonia
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Staphylococcal Pneumonia
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Staphylococcal Pneumonia
Oslers Node
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Pseudomonas Pneumonia
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Pseudomonas Pneumonia
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Pseudomonas Pneumonia
Ecthyma gangrenosum
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Immunofluorescent Ab Test
RSV Antigen Detection
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Legionella Pneumonia
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Legionella Pneumonia
Legionella pneumophila by Silver
impregnation Stain
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Pneumonia in COPD
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CMV Inclusion in BAL
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Sputum Gram Stain
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Treatment of CAP lt60yrs/OPD/no Comorbid
conditions

• Pathogens
• S. pneumoniae, Mycoplasma Chlamydia
  pneumoniae, H. indfluenzae, RSV, Legionella, S.
  aureus
• Treatment
• 2nd Generation Cephalosporin Macrolide or
  Quinolone monotherapy

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Treatment of CAP gt60yrs/OPD/with Comorbid
conditions

• Pathogens
• S. pneumoniae, RSV, H. indfluenzae, Gram (-)
  rod, S. aureus, Morexella catarrhalis, Legionella
  spp.
• Treatment
• 2nd Generation Cephalosporin TMX/SFX, or
  beta lactam/betalactam inhibitor Macrolide

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Treatment of Severe CAP

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

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Aspiration Pneumonia
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Aspiration Pneumonia
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Lipoid Pneumonia
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Lipoid Pneumonia