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LEARNING OBJECTIVES

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), and hospital-associated pneumonia (HAP).

  2. Explain the pathophysiology of pneumonia and associated host defenses.

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

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

  5. Design an appropriate empirical antimicrobial regimen based on patient-specific data for an individual with CAP, aspiration pneumonia, HAP, and VAP.

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

  7. Develop a monitoring plan based on patient-specific information for a patient with one of the four categories of pneumonia.

  8. Apply the complete Patient Care Process to caring for patients with any type of pneumonia.

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

  10. Explain prevention of pneumonia via immunization and include who the appropriate patient groups are for receiving the various vaccines.

INTRODUCTION

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 four classifications of pneumonia: community-acquired, aspiration, hospital-acquired, and ventilator-associated. Patients who develop pneumonia in the outpatient setting and have not been in any health care 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 Ventilator-associated pneumonia (VAP) requires endotracheal intubation for at least 48 hours before the onset of pneumonia.1 Health care–associated pneumonia was addressed in the 2005 VAP and HAP guidelines but was eliminated in the 2016 guidelines due to the lack of resistant organisms associated as the cause.2 The CAP guidelines might address health care–associated pneumonia; however, the updated guidelines will not be available until summer 2018 which is after the printing of this edition.

EPIDEMIOLOGY AND ETIOLOGY

Etiology and Mortality Rates

Image not available. The etiology of bacterial pneumonia varies in accordance with the type of pneumonia. Table 71–1 lists the more common pathogens associated with the various types or classifications of pneumonia. Streptococcus pneumoniae colonizes the nasopharyngeal flora in up to 50% of healthy adults and may colonize the lower airways in individuals with chronic bronchitis.2,3 It possesses many virulence factors, enhancing its ability to cause infection in the respiratory tract. Image not available. Therefore, it is not surprising that S. pneumoniae is the predominant bacterial pathogen associated with CAP. The second most common pathogen is one of the atypical organisms, Mycoplasma pneumoniae. Nontypeable Haemophilus influenzae intermittently colonizes about 80% of the population, and the incidence of permanent colonization increases in chronic obstructive pulmonary disease (COPD) patients and those with cystic fibrosis. Therefore, the ...

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