CICM SAQ 2012.1 Q18
Questions
- a) List the clinical features that indicate a poor prognosis in a patient with community-acquired pneumonia?
- b) List 5 common organisms causing severe community acquired pneumonia in immunocompetent adults.
- c) What are the possible reasons for non-response to empiric treatment for patients treated for severe community acquired pneumonia?
- d) Briefly outline your approach to stopping antibiotics given for CAP responding to empiric treatment in ICU?
Answers
Answer and interpretation
a) List the clinical features that indicate a poor prognosis in a patient with community-acquired pneumonia?
Major criteria
- invasive mechanical ventilation
- septic shock with the need for vasopressors
Minor criteria
- respiratory rate >30/min
- PaO2/FiO2 ratio >250
- multilobar infiltrates
- confusion/ disorientation
- uremia
- leukopenia (WBC <4,000 cells/mm3)
- thrombocytopenia (<100,000 cells/mm3)
- hypothermia (T<36C)
- hypotension requiring aggressive fluid resusitation
b) List 5 common organisms causing severe community acquired pneumonia in immunocompetent adults.
- Streptococcus pneumonia
- Legionella spp
- Haemophilus influenza
- Klebsiella pneumonia
- Staphylococcus aureus
- Respiratory viruses
- Mycoplasma
c) What are the possible reasons for non-response to empiric treatment for patients treated for severe community acquired pneumonia?
Wrong diagnosis
- Cardiac failure
- PE
- Pulmonary haemorrhage
- Interstitial lung disease
Wrong antibiotics
- Resistant organism e.g.: MRSA
- Wrong organism: e.g.: viral pneumonitis
Wrong dose
- Under dosing (gentamicin, vancomycin)
- Wrong interval (vancomycin, cephalosporins)
Complication of the disease
- Empyema
- Lung abscess
Complication of treatment
- Antibiotic reaction
- Superinfection
Underlying disease
- Cancer
- Airway obstruction
- Severe emphysema with bullae
d) Briefly outline your approach to stopping antibiotics given for CAP responding to empiric treatment in ICU?
- Evidence in area is complicated, but in resolving CAP- 7-10 days most common in studies
- 5 days seems the minimum
- More than 8 days may be associated with super infection with resistant organisms.
- Pseudomonas- may need 15 days Legionella 3 weeks
- Biomarkers e.g. procalcitonin in some RCTS
Examination Library
CICM
Chris is an Intensivist and ECMO specialist at The Alfred ICU, where he is Deputy Director (Education). He is a Clinical Adjunct Associate Professor at Monash University, the Lead for the Clinician Educator Incubator programme, and a CICM First Part Examiner.
He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives. He was one of the founders of the FOAM movement (Free Open-Access Medical education) has been recognised for his contributions to education with awards from ANZICS, ANZAHPE, and ACEM.
His one great achievement is being the father of three amazing children.
On Bluesky, he is @precordialthump.bsky.social and on the site that Elon has screwed up, he is @precordialthump.
| INTENSIVE | RAGE | Resuscitology | SMACC