Pneumonia, Bacterial
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Basics
Bacterial pneumonia is an infection of the pulmonary parenchyma by a bacterial organism.
Description
Bacterial pneumonia can be classified as the following:
- Community-acquired pneumonia (CAP): acute infection of the pulmonary parenchyma acquired outside of a health care setting or long-term care facility
- Nosocomial pneumonia: acute infection of the pulmonary parenchyma acquired in health care settings
- Hospital-acquired pneumonia (HAP): occurs ≥48 hours after admission and did not appear to be incubating at time of admission
- Ventilator-associated pneumonia (VAP): pneumonia develops >48 hours after endotracheal intubation
- Health care–associated pneumonia (HCAP): This categorization is no longer used.
Epidemiology
- In the United States as of 2018, CAP is the eighth most common cause of death (even higher in those >65) and most common cause of death related to infection.
- Pneumonia causes 3.2 million estimated deaths.
- HAP is the leading cause of death among nosocomial infections and is one of the leading causes of death in the ICU.
- Rates of infection are 3 times higher in African Americans than in whites and are 5 to 10 times higher in Native American adults and 10 times higher in Native American children.
- Mortality rate in children is approximately 1.6 million a year. Hospitalization rate for children with CAP is still highest among the very young ages (<18 months). Respiratory viruses are the most commonly detected causes of pneumonia in children (1).
Incidence
- CAP: 5 to 6 cases per 1,000 persons with increased incidence occurring in the winter months
- HAP: 5 to 20 cases per 1,000 admissions; incidence increases 6- to 20-fold in ventilated patients
Etiology and Pathophysiology
- Pathogenicity of the implicated organisms informs the presentation and antibiotic choice.
- Adults, CAP
- Typical (85%): Streptococcus pneumoniae, Haemophilus influenzae, Staphylococcus aureus, group A Streptococcus, Moraxella catarrhalis
- Atypical (15%): Legionella sp., Mycoplasma pneumoniae, Chlamydophila pneumoniae
- Adults, HCAP/HAP/VAP
- Aerobic gram-negative bacilli: Pseudomonas aeruginosa, Escherichia coli, Klebsiella pneumoniae, and Acinetobacter sp.
- Gram-positive cocci: Streptococcus sp. and S. aureus (including MRSA)
- Pediatric
- Birth to 3 weeks: E. coli, group B streptococci, Listeria monocytogenes
- <3 months: Chlamydia trachomatis, S. pneumoniae, H. influenzae
- 3 months to 18 years
- Typical: S. pneumoniae
- Atypical: C. pneumoniae, M. pneumoniae
Risk Factors
- Immunosuppression:
- Chronic steroid use (>20 mg/day or >2 mg/kg/day of prednisone for >14 days)
- HIV/immunoglobulin deficiencies/solid organ transplant/TNF-α inhibitor therapy
- Chronic health conditions:
- Asthma, COPD
- Type 2 DM, chronic renal failure, CHF, liver disease, tobacco use
- Other:
- Age >65 years
- Antibiotic therapy in the past 6 months/resistance to antibiotics
- Hospitalization for ≥2 days during past 90 days
- Poor functional status as defined by activities of daily living score
General Prevention
Vaccination recommendations:
- All children 2 to 59 months of age should be routinely vaccinated with pneumococcal conjugate (PCV13); given at 2, 4, and 6 months of age; a fourth dose at 12 to 15 months of age
- Adults ≥65 years who are vaccine naïve: should receive PPSV23 only. Adults >65 years old in the high risk group should receive PCV13 followed by pneumococcal polysaccharide (PPSV23) ≥1 year interval.
- For adults ≥65 years old in the high risk group who have already received PPSV23, a dose of PCV13 is indicated after ≥1 year.
- Adults 19 to 64 years with tobacco use, chronic heart or lung disease, alcoholism, or chronic liver disease should receive a dose of PPSV23, followed by PCV13 at age 65 and a subsequent PPSV23 ≥1 year after PCV13 and at least 5 years after the previous PPSV23 dose.
- High-risk adults ≥19 years old with immunocompromising conditions: asplenia, CSF leaks, cochlear implants, HIV infection, immunodeficiencies: 1 dose of PCV13 followed by PPSV23 after ≥8 weeks. A second dose of PPSV23 is recommended for all except those with CSF leak or cochlear implant, it should be given 5 years after first dose. A final dose of PPSV23 should be administered at age 65 and at least 5 years after the previous dose. Those who were previously given PPSV23 should receive a PCV13 dose ≥1 year after last PPSV23. If additional PPSV23 is required, it should be given ≥8 weeks after PCV13 and 5 years after most recent dose of PPSV23.
- Annual influenza vaccine
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Basics
Bacterial pneumonia is an infection of the pulmonary parenchyma by a bacterial organism.
Description
Bacterial pneumonia can be classified as the following:
- Community-acquired pneumonia (CAP): acute infection of the pulmonary parenchyma acquired outside of a health care setting or long-term care facility
- Nosocomial pneumonia: acute infection of the pulmonary parenchyma acquired in health care settings
- Hospital-acquired pneumonia (HAP): occurs ≥48 hours after admission and did not appear to be incubating at time of admission
- Ventilator-associated pneumonia (VAP): pneumonia develops >48 hours after endotracheal intubation
- Health care–associated pneumonia (HCAP): This categorization is no longer used.
Epidemiology
- In the United States as of 2018, CAP is the eighth most common cause of death (even higher in those >65) and most common cause of death related to infection.
- Pneumonia causes 3.2 million estimated deaths.
- HAP is the leading cause of death among nosocomial infections and is one of the leading causes of death in the ICU.
- Rates of infection are 3 times higher in African Americans than in whites and are 5 to 10 times higher in Native American adults and 10 times higher in Native American children.
- Mortality rate in children is approximately 1.6 million a year. Hospitalization rate for children with CAP is still highest among the very young ages (<18 months). Respiratory viruses are the most commonly detected causes of pneumonia in children (1).
Incidence
- CAP: 5 to 6 cases per 1,000 persons with increased incidence occurring in the winter months
- HAP: 5 to 20 cases per 1,000 admissions; incidence increases 6- to 20-fold in ventilated patients
Etiology and Pathophysiology
- Pathogenicity of the implicated organisms informs the presentation and antibiotic choice.
- Adults, CAP
- Typical (85%): Streptococcus pneumoniae, Haemophilus influenzae, Staphylococcus aureus, group A Streptococcus, Moraxella catarrhalis
- Atypical (15%): Legionella sp., Mycoplasma pneumoniae, Chlamydophila pneumoniae
- Adults, HCAP/HAP/VAP
- Aerobic gram-negative bacilli: Pseudomonas aeruginosa, Escherichia coli, Klebsiella pneumoniae, and Acinetobacter sp.
- Gram-positive cocci: Streptococcus sp. and S. aureus (including MRSA)
- Pediatric
- Birth to 3 weeks: E. coli, group B streptococci, Listeria monocytogenes
- <3 months: Chlamydia trachomatis, S. pneumoniae, H. influenzae
- 3 months to 18 years
- Typical: S. pneumoniae
- Atypical: C. pneumoniae, M. pneumoniae
Risk Factors
- Immunosuppression:
- Chronic steroid use (>20 mg/day or >2 mg/kg/day of prednisone for >14 days)
- HIV/immunoglobulin deficiencies/solid organ transplant/TNF-α inhibitor therapy
- Chronic health conditions:
- Asthma, COPD
- Type 2 DM, chronic renal failure, CHF, liver disease, tobacco use
- Other:
- Age >65 years
- Antibiotic therapy in the past 6 months/resistance to antibiotics
- Hospitalization for ≥2 days during past 90 days
- Poor functional status as defined by activities of daily living score
General Prevention
Vaccination recommendations:
- All children 2 to 59 months of age should be routinely vaccinated with pneumococcal conjugate (PCV13); given at 2, 4, and 6 months of age; a fourth dose at 12 to 15 months of age
- Adults ≥65 years who are vaccine naïve: should receive PPSV23 only. Adults >65 years old in the high risk group should receive PCV13 followed by pneumococcal polysaccharide (PPSV23) ≥1 year interval.
- For adults ≥65 years old in the high risk group who have already received PPSV23, a dose of PCV13 is indicated after ≥1 year.
- Adults 19 to 64 years with tobacco use, chronic heart or lung disease, alcoholism, or chronic liver disease should receive a dose of PPSV23, followed by PCV13 at age 65 and a subsequent PPSV23 ≥1 year after PCV13 and at least 5 years after the previous PPSV23 dose.
- High-risk adults ≥19 years old with immunocompromising conditions: asplenia, CSF leaks, cochlear implants, HIV infection, immunodeficiencies: 1 dose of PCV13 followed by PPSV23 after ≥8 weeks. A second dose of PPSV23 is recommended for all except those with CSF leak or cochlear implant, it should be given 5 years after first dose. A final dose of PPSV23 should be administered at age 65 and at least 5 years after the previous dose. Those who were previously given PPSV23 should receive a PCV13 dose ≥1 year after last PPSV23. If additional PPSV23 is required, it should be given ≥8 weeks after PCV13 and 5 years after most recent dose of PPSV23.
- Annual influenza vaccine
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