Page 382 - ACCCN's Critical Care Nursing

Respiratory Alterations and Management 359

TABLE 14.5 Clinical history/comorbidities associated with particular causative organisms in CAP

Condition Causative organisms
Individual factors
Alcoholism Streptococcus pneumoniae (including penicillin-resistant), anaerobes,
gram-negative bacilli (possibly Klebsiella pneumoniae), tuberculosis
Poor dental hygiene Anaerobes
Elderly group B streptococci, Moraxella catarrhalis, H. influenzae, L. pneumophila,
gram-negative bacilli, C. pneumoniae and polymicrobial infections
Smoking (past or present) S. pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, Aspergillus
spp.
IV Drug use S. aureus, anerobes, M. tuberculosis, S. pneumoniae
Comorbidities
COPD S. pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, Aspergillus
spp.
Post influenza pneumonia S. pneumoniae, S. aureus, H. influenzae
Structural disease of lung (e.g., bronchiectasis, cystic fibrosis) P. aeruginosa, P. cepacia or Staphylococcus aureus
Sickle cell disease, asplenia Pneumococccus, H. influenzae
Previous antibiotic treatment and severe pulmonary comorbidity, P. aeruginosa
(e.g. bronchiectasis, cystic fibrosis, and severe COPD)
Malnutrition related diseases Gram-negative bacilli
Environmental exposure
Air conditioning Legionella pneumophila
Residence in nursing home S. pneumoniae, gram-negative bacilli, H. influenzae, S. aureus, Chlamydia
pneumoniae; consider M. tuberculosis. Consider anaerobes, but less
common.
Homeless population S. pneumoniae, S. aureus, H. influenzae, Cryptococcus gattii: caused by
inhalation of spores while sleeping, associated with red gum trees
(Australia, Southeast Asia, South America)
Suspected bioterrorism Anthrax, tularaemia, plague
Animal exposure
Bat exposure Histoplasma capsulatum
Bird exposure Chlamydia psittaci, Cryptococcus neoformans, H. capsulatum
Rabbit exposure Francisella tularensis
Exposure to farm animals or parturient cats Coxiella burnetii (Q fever)
Travel history
Travel to southwestern USA Coccidioidomycosis; hantavirus in selected areas
Travel to southeast Asia Severe acute respiratory syndrome (coronavirus), Mycobacterium
tuberculosis, melioidosis
Residence or travel to rural tropics Melioidosis (Burkholderia pseudomallei)
Travel to area of known epidemic Avian influenza (H5N1), Swine influenza (H1N1) and SARS (coronavirus)

● Clinical Strategy: involves treatment of patients with the diagnosis and causative organism. Antibiotic
new antibiotics, based on patient risk factors and the therapy is then guided by specific protocols.
local microbiologic and resistance patterns. Therapy is
adjusted based on culture results and the patient’s
response to treatment. CLINICAL MANIFESTATIONS
● Invasive Strategy: involves collection and quantitative Symptoms for pneumonia are both respiratory and sys-
analysis of respiratory secretions from samples temic. Common characteristics include fever, sweats,
obtained by bronchoalveolar lavage (BAL) to confirm rigours, cough, sputum production, pleuritic chest pain,