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LEARNING OBJECTIVES

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LEARNING OBJECTIVES

Upon completion of the chapter, the reader will be able to:

  1. List the common pathogens that cause community-acquired pneumonia (CAP), aspiration pneumonia, ventilator-associated pneumonia (VAP; early versus late onset), and healthcare-associated pneumonia.

  2. Explain the host defenses that protect against infection.

  3. Explain the pathophysiology of pneumonia.

  4. List the signs and symptoms associated with CAP and VAP.

  5. Identify patient and organism factors required to guide the selection of a specific antimicrobial regimen for an individual patient.

  6. Design an appropriate empirical antimicrobial regimen based on patient-specific data for an individual with CAP, aspiration pneumonia, and VAP or healthcare-associated pneumonia (early versus late onset).

  7. Design an appropriate antimicrobial regimen based on both patient- and organism-specific data.

  8. Develop a monitoring plan based on patient-specific information for a patient with CAP and healthcare-associated pneumonia or VAP.

  9. Formulate appropriate educational information to be provided to a patient with pneumonia.

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KEY CONCEPTS

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  • Image not available. There are five classifications of pneumonia: community-acquired, aspiration, hospital-acquired, ventilator-associated, and healthcare-associated.

  • Image not available. The etiology of bacterial pneumonia varies in accordance with the type of pneumonia.

  • Image not available. Streptococcus pneumoniae is the most common bacterial pathogen associated with community-acquired pneumonia (CAP).

  • Image not available. The signs and symptoms and severity of pneumonia are needed not only to diagnose the infection but also to determine and assess response to therapy.

  • Image not available. The goal of therapy is to eliminate the patient's symptoms, minimize or prevent complications, and decrease mortality.

  • Image not available. Antimicrobial treatment of CAP is predominantly empirical.

  • Image not available. Selection of antimicrobial therapy for ventilator-associated, health-care associated, and hospital-associated pneumonia is empirical and broad spectrum; however, once culture and susceptibility information are available, the antimicrobial therapy should be narrowed (de-escalation) to cover the identified pathogen(s).

  • Image not available. Duration of antimicrobial therapy should be kept to the shortest length possible.

  • Image not available. Monitoring response to therapy is essential for determining efficacy, identifying adverse reactions, and determining the duration of therapy.

  • Image not available. Prevention of both pneumococcal and influenza pneumonia by use of vaccination is a national goal.

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Pneumonia is inflammation of the lung with consolidation. The cause of the inflammation is infection, which can be caused by a wide range of organisms. Image not available. There are five classifications of pneumonia: community-acquired, aspiration, hospital-acquired, ventilator-associated, and healthcare-associated. Patients who develop pneumonia in the outpatient setting and have not been in any healthcare facilities, which include wound care and hemodialysis clinics, have community-acquired pneumonia (CAP). Pneumonia can be caused by aspiration of either oropharyngeal or gastrointestinal contents. Hospital-acquired pneumonia (HAP) is defined as pneumonia that occurs 48 hours or more after admission.1,2 Ventilator-associated pneumonia (VAP) requires endotracheal intubation for at least 48 to 72 hours before the onset of pneumonia.2,3 The newest category is healthcare-associated pneumonia (HCAP), which is defined as pneumonia occurring in any patient hospitalized for at least 2 days within 90 days of the onset of the infection; residing in a nursing home or long-term care facility; received IV antibiotic therapy, wound care, or chemotherapy within the ...

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