![Page 1: Bacterial Pneumonia Sung Chul Hwang, M.D. Dept. of Pulmonary and Critical Care Medicine Ajou University School of Medicine](https://reader035.vdocuments.us/reader035/viewer/2022062516/56649d415503460f94a1b884/html5/thumbnails/1.jpg)
Bacterial Pneumonia
Sung Chul Hwang, M.D.
Dept. of Pulmonary and Critical Care Medicine
Ajou University School of Medicine
![Page 2: Bacterial Pneumonia Sung Chul Hwang, M.D. Dept. of Pulmonary and Critical Care Medicine Ajou University School of Medicine](https://reader035.vdocuments.us/reader035/viewer/2022062516/56649d415503460f94a1b884/html5/thumbnails/2.jpg)
Epidemiology
• 6th leading cause of death in U.S.• Number one Among the infectious disea
ses• 4 million patients annually in US• Incidence 12/1,000/year• Mortality in OPD patients 1-5 %, but Inp
atients 25%, ICU 50-60%
![Page 3: Bacterial Pneumonia Sung Chul Hwang, M.D. Dept. of Pulmonary and Critical Care Medicine Ajou University School of Medicine](https://reader035.vdocuments.us/reader035/viewer/2022062516/56649d415503460f94a1b884/html5/thumbnails/3.jpg)
Definition
• Pneumonia is the inflammation of lower respiratory tracts including alveoli, interstitial tissues, and broncioles by the microorganisms, chemical irritations or by an immunological process
![Page 4: Bacterial Pneumonia Sung Chul Hwang, M.D. Dept. of Pulmonary and Critical Care Medicine Ajou University School of Medicine](https://reader035.vdocuments.us/reader035/viewer/2022062516/56649d415503460f94a1b884/html5/thumbnails/4.jpg)
Classifications & Terminology
• Community Acquired Pneumonia Nosocomial Pneumonia Ventilator Associated Pneumionia• Mild, moderate, severe • Bacterial, viral, fungal, parasitic• Primary vs. Secondary• Immune compromised vs. Normal immunity• Lobar vs interstitial• Typical vs. Atypical
![Page 5: Bacterial Pneumonia Sung Chul Hwang, M.D. Dept. of Pulmonary and Critical Care Medicine Ajou University School of Medicine](https://reader035.vdocuments.us/reader035/viewer/2022062516/56649d415503460f94a1b884/html5/thumbnails/5.jpg)
![Page 6: Bacterial Pneumonia Sung Chul Hwang, M.D. Dept. of Pulmonary and Critical Care Medicine Ajou University School of Medicine](https://reader035.vdocuments.us/reader035/viewer/2022062516/56649d415503460f94a1b884/html5/thumbnails/6.jpg)
![Page 7: Bacterial Pneumonia Sung Chul Hwang, M.D. Dept. of Pulmonary and Critical Care Medicine Ajou University School of Medicine](https://reader035.vdocuments.us/reader035/viewer/2022062516/56649d415503460f94a1b884/html5/thumbnails/7.jpg)
![Page 8: Bacterial Pneumonia Sung Chul Hwang, M.D. Dept. of Pulmonary and Critical Care Medicine Ajou University School of Medicine](https://reader035.vdocuments.us/reader035/viewer/2022062516/56649d415503460f94a1b884/html5/thumbnails/8.jpg)
![Page 9: Bacterial Pneumonia Sung Chul Hwang, M.D. Dept. of Pulmonary and Critical Care Medicine Ajou University School of Medicine](https://reader035.vdocuments.us/reader035/viewer/2022062516/56649d415503460f94a1b884/html5/thumbnails/9.jpg)
![Page 10: Bacterial Pneumonia Sung Chul Hwang, M.D. Dept. of Pulmonary and Critical Care Medicine Ajou University School of Medicine](https://reader035.vdocuments.us/reader035/viewer/2022062516/56649d415503460f94a1b884/html5/thumbnails/10.jpg)
![Page 11: Bacterial Pneumonia Sung Chul Hwang, M.D. Dept. of Pulmonary and Critical Care Medicine Ajou University School of Medicine](https://reader035.vdocuments.us/reader035/viewer/2022062516/56649d415503460f94a1b884/html5/thumbnails/11.jpg)
![Page 12: Bacterial Pneumonia Sung Chul Hwang, M.D. Dept. of Pulmonary and Critical Care Medicine Ajou University School of Medicine](https://reader035.vdocuments.us/reader035/viewer/2022062516/56649d415503460f94a1b884/html5/thumbnails/12.jpg)
Severe Community Acquired Pneumonia
• Respiratory rate > 30/min• PaO2/FiO2 ratio < 250mmHg• Need for Mechanical Ventilation• Diffuse bilateral involvement or multiple lobes,
incresing infiltration > 50% within 48 hours• B.P. < 90systolic or 60 mmHg diastolic• Need for vasopressors• Renal failure
![Page 13: Bacterial Pneumonia Sung Chul Hwang, M.D. Dept. of Pulmonary and Critical Care Medicine Ajou University School of Medicine](https://reader035.vdocuments.us/reader035/viewer/2022062516/56649d415503460f94a1b884/html5/thumbnails/13.jpg)
Mycoplasma Pneumonia
![Page 14: Bacterial Pneumonia Sung Chul Hwang, M.D. Dept. of Pulmonary and Critical Care Medicine Ajou University School of Medicine](https://reader035.vdocuments.us/reader035/viewer/2022062516/56649d415503460f94a1b884/html5/thumbnails/14.jpg)
Mycoplasma Pneumonia
![Page 15: Bacterial Pneumonia Sung Chul Hwang, M.D. Dept. of Pulmonary and Critical Care Medicine Ajou University School of Medicine](https://reader035.vdocuments.us/reader035/viewer/2022062516/56649d415503460f94a1b884/html5/thumbnails/15.jpg)
Mycoplasma Pneumonia
![Page 16: Bacterial Pneumonia Sung Chul Hwang, M.D. Dept. of Pulmonary and Critical Care Medicine Ajou University School of Medicine](https://reader035.vdocuments.us/reader035/viewer/2022062516/56649d415503460f94a1b884/html5/thumbnails/16.jpg)
Streptococcal Pneumonia
![Page 17: Bacterial Pneumonia Sung Chul Hwang, M.D. Dept. of Pulmonary and Critical Care Medicine Ajou University School of Medicine](https://reader035.vdocuments.us/reader035/viewer/2022062516/56649d415503460f94a1b884/html5/thumbnails/17.jpg)
Streptococcus pneumoniae
Gram + Diplococci
![Page 18: Bacterial Pneumonia Sung Chul Hwang, M.D. Dept. of Pulmonary and Critical Care Medicine Ajou University School of Medicine](https://reader035.vdocuments.us/reader035/viewer/2022062516/56649d415503460f94a1b884/html5/thumbnails/18.jpg)
Streptococcal Pneumonia
![Page 19: Bacterial Pneumonia Sung Chul Hwang, M.D. Dept. of Pulmonary and Critical Care Medicine Ajou University School of Medicine](https://reader035.vdocuments.us/reader035/viewer/2022062516/56649d415503460f94a1b884/html5/thumbnails/19.jpg)
Streptococcal Pneumonia
![Page 20: Bacterial Pneumonia Sung Chul Hwang, M.D. Dept. of Pulmonary and Critical Care Medicine Ajou University School of Medicine](https://reader035.vdocuments.us/reader035/viewer/2022062516/56649d415503460f94a1b884/html5/thumbnails/20.jpg)
Staphylococcus aureus
BAL Fluid
![Page 21: Bacterial Pneumonia Sung Chul Hwang, M.D. Dept. of Pulmonary and Critical Care Medicine Ajou University School of Medicine](https://reader035.vdocuments.us/reader035/viewer/2022062516/56649d415503460f94a1b884/html5/thumbnails/21.jpg)
Staphylococcal Pneumonia
Pneumatocele
![Page 22: Bacterial Pneumonia Sung Chul Hwang, M.D. Dept. of Pulmonary and Critical Care Medicine Ajou University School of Medicine](https://reader035.vdocuments.us/reader035/viewer/2022062516/56649d415503460f94a1b884/html5/thumbnails/22.jpg)
Staphylococcal Pneumonia
![Page 23: Bacterial Pneumonia Sung Chul Hwang, M.D. Dept. of Pulmonary and Critical Care Medicine Ajou University School of Medicine](https://reader035.vdocuments.us/reader035/viewer/2022062516/56649d415503460f94a1b884/html5/thumbnails/23.jpg)
Staphylococcal Pneumonia
![Page 24: Bacterial Pneumonia Sung Chul Hwang, M.D. Dept. of Pulmonary and Critical Care Medicine Ajou University School of Medicine](https://reader035.vdocuments.us/reader035/viewer/2022062516/56649d415503460f94a1b884/html5/thumbnails/24.jpg)
Staphylococcal Pneumonia
Osler’s Node
![Page 25: Bacterial Pneumonia Sung Chul Hwang, M.D. Dept. of Pulmonary and Critical Care Medicine Ajou University School of Medicine](https://reader035.vdocuments.us/reader035/viewer/2022062516/56649d415503460f94a1b884/html5/thumbnails/25.jpg)
Pseudomonas Pneumonia
![Page 26: Bacterial Pneumonia Sung Chul Hwang, M.D. Dept. of Pulmonary and Critical Care Medicine Ajou University School of Medicine](https://reader035.vdocuments.us/reader035/viewer/2022062516/56649d415503460f94a1b884/html5/thumbnails/26.jpg)
Pseudomonas Pneumonia
![Page 27: Bacterial Pneumonia Sung Chul Hwang, M.D. Dept. of Pulmonary and Critical Care Medicine Ajou University School of Medicine](https://reader035.vdocuments.us/reader035/viewer/2022062516/56649d415503460f94a1b884/html5/thumbnails/27.jpg)
Pseudomonas Pneumonia
Ecthyma gangrenosum
![Page 28: Bacterial Pneumonia Sung Chul Hwang, M.D. Dept. of Pulmonary and Critical Care Medicine Ajou University School of Medicine](https://reader035.vdocuments.us/reader035/viewer/2022062516/56649d415503460f94a1b884/html5/thumbnails/28.jpg)
Immunofluorescent Ab Test
RSV Antigen Detection
![Page 29: Bacterial Pneumonia Sung Chul Hwang, M.D. Dept. of Pulmonary and Critical Care Medicine Ajou University School of Medicine](https://reader035.vdocuments.us/reader035/viewer/2022062516/56649d415503460f94a1b884/html5/thumbnails/29.jpg)
Legionella Pneumonia
![Page 30: Bacterial Pneumonia Sung Chul Hwang, M.D. Dept. of Pulmonary and Critical Care Medicine Ajou University School of Medicine](https://reader035.vdocuments.us/reader035/viewer/2022062516/56649d415503460f94a1b884/html5/thumbnails/30.jpg)
Legionella Pneumonia
Legionella pneumophila by Silver impregnation Stain
![Page 31: Bacterial Pneumonia Sung Chul Hwang, M.D. Dept. of Pulmonary and Critical Care Medicine Ajou University School of Medicine](https://reader035.vdocuments.us/reader035/viewer/2022062516/56649d415503460f94a1b884/html5/thumbnails/31.jpg)
Pneumonia in COPD
![Page 32: Bacterial Pneumonia Sung Chul Hwang, M.D. Dept. of Pulmonary and Critical Care Medicine Ajou University School of Medicine](https://reader035.vdocuments.us/reader035/viewer/2022062516/56649d415503460f94a1b884/html5/thumbnails/32.jpg)
CMV Inclusion in BAL
![Page 33: Bacterial Pneumonia Sung Chul Hwang, M.D. Dept. of Pulmonary and Critical Care Medicine Ajou University School of Medicine](https://reader035.vdocuments.us/reader035/viewer/2022062516/56649d415503460f94a1b884/html5/thumbnails/33.jpg)
Sputum Gram Stain
![Page 34: Bacterial Pneumonia Sung Chul Hwang, M.D. Dept. of Pulmonary and Critical Care Medicine Ajou University School of Medicine](https://reader035.vdocuments.us/reader035/viewer/2022062516/56649d415503460f94a1b884/html5/thumbnails/34.jpg)
Treatment of CAP <60yrs/OPD/no Comorbid conditions
• Pathogens : S. pneumoniae, Mycoplasma& Chlamydia pne
umoniae, H. indfluenzae, RSV, Legionella, S. aureus
• Treatment : 2nd Generation Cephalosporin + Macrolide or Q
uinolone monotherapy
![Page 35: Bacterial Pneumonia Sung Chul Hwang, M.D. Dept. of Pulmonary and Critical Care Medicine Ajou University School of Medicine](https://reader035.vdocuments.us/reader035/viewer/2022062516/56649d415503460f94a1b884/html5/thumbnails/35.jpg)
Treatment of CAP >60yrs/OPD/with Comorbid conditions
• Pathogens : S. pneumoniae, RSV, H. indfluenzae, Gram (-)
rod, S. aureus, Morexella catarrhalis, Legionella spp.
• Treatment : 2nd Generation Cephalosporin + TMX/SFX, or
beta lactam/betalactam inhibitor + Macrolide
![Page 36: Bacterial Pneumonia Sung Chul Hwang, M.D. Dept. of Pulmonary and Critical Care Medicine Ajou University School of Medicine](https://reader035.vdocuments.us/reader035/viewer/2022062516/56649d415503460f94a1b884/html5/thumbnails/36.jpg)
Treatment of Severe CAP
• Pathogens : S. pneumoniae, Legionella spp. Gram (-)
rod, Mycoplasma,H. indfluenzae,S. aureus • Treatment : 3rd Generation Cephalosporin with anti-Pseud
omonal activity or + other anti Pseudomonal agent (Imipenem/quinolone) + Macrolide
![Page 37: Bacterial Pneumonia Sung Chul Hwang, M.D. Dept. of Pulmonary and Critical Care Medicine Ajou University School of Medicine](https://reader035.vdocuments.us/reader035/viewer/2022062516/56649d415503460f94a1b884/html5/thumbnails/37.jpg)
Aspiration Pneumonia
![Page 38: Bacterial Pneumonia Sung Chul Hwang, M.D. Dept. of Pulmonary and Critical Care Medicine Ajou University School of Medicine](https://reader035.vdocuments.us/reader035/viewer/2022062516/56649d415503460f94a1b884/html5/thumbnails/38.jpg)
Aspiration Pneumonia
![Page 39: Bacterial Pneumonia Sung Chul Hwang, M.D. Dept. of Pulmonary and Critical Care Medicine Ajou University School of Medicine](https://reader035.vdocuments.us/reader035/viewer/2022062516/56649d415503460f94a1b884/html5/thumbnails/39.jpg)
Lipoid Pneumonia
![Page 40: Bacterial Pneumonia Sung Chul Hwang, M.D. Dept. of Pulmonary and Critical Care Medicine Ajou University School of Medicine](https://reader035.vdocuments.us/reader035/viewer/2022062516/56649d415503460f94a1b884/html5/thumbnails/40.jpg)
Lipoid Pneumonia