Flea Bytes: Treating Aspiration Pneumonia

For most patients: Ampicillin/Sulbactam is sufficient for oral aerobe/anaerobic coverage

For penicillin allergic patients: Clindamycin monotherapy covers oral aerobes/anaerobes

For hospital-acquired aspiration PNA: Coverage of aerobic bacteria, especially GPC and GNR are more important than anaerobes: Pip/Tazo or meropenem monotherapy

In patients with high risk factors for MRSA, can add an agent with MRSA activity but if MRSA is not detected, this agent should be discontinued

Tidings from the Citadel: Accuracy of Lung Ultrasonography in the Diagnosis of Pneumonia

16 studies were included – significant heterogeneity, but of 2359 patients. Heterogeneity was assessed graphically and with a Q test. The Q test should only be used once in a data set to exclude outliers. The reference standard, we considered it to be of high quality if based on CT alone or when it consisted of a final diagnosis made by experts using an integrated synthesis of radiology and laboratory or microbiological data (or both).

The highest risk of bias stemmed from the flow of patients within each study because of an uneven application of the reference test (differential verification bias).

The dispersion of studies in the ROC plane suggests marked heterogeneity.
The 95% CI of the overall effect indicates a sensitivity of approximately 80% to 90% and a specificity of 70% to 90%.

References:
Accuracy of Lung Ultrasonography in the Diagnosis of Pneumonia in Adults: Systematic Review and Meta-Analysis – Ana M. Llamas-Álvarez, MD; Eva M. Tenza-Lozano, MD; and Jaime Latour-Pérez, MD, PhD; . Chest 2017; 151(2):374-382

Flea Bytes: Hospital Acquired Pneumonia (HAP)

  • Definition: pneumonia that occurs 48 hours or more after admission and did not appear to be incubating at the time of admission.
  • HCAP Removed because many patients who met criteria were in fact not at increased risk for multi-drug resistant organisms, MDROs
  • Recommended antibiotics: anti-pseudomonal +/- double pseudomonal coverage +/- MRSA coverage
  • MRSA Risks: abx use IV abx in past 90 days, unit where prevalence of MRSA among S. aureus isolates is not known or >20%. No recommendations regarding use of MRSA swab to guide need for MRSA coverage.
  • Non-invasive Sputum cultures recommended to guide therapy
  • Duration: 7 days
  • New CAP guidelines (to include patients from nursing homes) are pending.

Reference:

http://www.idsociety.org/Guidelines/Patient_Care/IDSA_Practice_Guidelines/Infections_by_Organ_System/Lower/Upper_Respiratory/Hospital-Acquired_Pneumonia_(HAP)/