Skip to Main Content

KEY CONCEPTS

KEY CONCEPTS

  • Image not available. Respiratory infections remain a major cause of morbidity from acute illness in the United States and represent the most common reasons why patients seek medical attention.

  • Image not available. The majority of pulmonary infections follow colonization of the upper respiratory tract with potential pathogens, whereas microbes less commonly gain access to the lungs via the bloodstream from an extrapulmonary source or by inhalation of infected aerosol particles. The competency of a patient's immune status is an important factor influencing the susceptibility to infection, etiologic cause, and disease severity.

  • Image not available. An appropriate treatment regimen for a patient with uncomplicated lower respiratory tract infection can be established by evaluating the patient history, physical examination, chest radiograph, and properly collected sputum for culture interpreted in light of current knowledge of the most common lung pathogens and their antibiotic susceptibility patterns within the community.

  • Image not available. Acute bronchitis is most commonly caused by respiratory viruses and is almost always self-limiting. Therapy targets associated symptoms such as lethargy, malaise, or fever and may include fluids for rehydration. Routine use of antibiotics should be avoided and medication to suppress cough is rarely indicated.

  • Image not available. Chronic bronchitis is caused by several interacting factors, including inhalation of noxious agents (most prominent are cigarette smoke and exposure to occupational dusts, fumes, and environmental pollution) and host factors including genetic factors and bacterial (and possibly viral) infections. The hallmark of this disease is a chronic cough, accompanied by excessive production, and expectoration of sputum with a persistent presence of microorganisms in the patient's sputum.

  • Image not available. Treatment of acute exacerbations of chronic bronchitis includes attempts to mobilize and enhance sputum expectoration (chest physiotherapy, humidification of inspired air), oxygen if needed, aerosolized bronchodilators in select patients with demonstrated benefit, and possibly antibiotics.

  • Image not available. Respiratory syncytial virus is the most common cause of acute bronchiolitis, an infection that mostly affects infants during their first year of life. In the well infant, bronchiolitis usually is a self-limiting viral illness.

  • Image not available. The most prominent pathogen causing community-acquired bacterial pneumonia in otherwise healthy adults is Streptococcus pneumoniae, whereas the most common pathogens causing hospital-acquired pneumonia are Staphylococcus aureus and gram-negative aerobic bacilli.

  • Image not available. Empiric antimicrobial therapy for pneumonia should consist of antibiotic regimens targeting presumed causative pathogens based on clinical presentation and patient-specific characteristics, local epidemiology, and resistance patterns.

  • Image not available. Microbiologic tests for pneumonia etiology should be performed when clinically indicated and used along with patient clinical response to tailor antibiotic therapy using evidence-based pathogen-directed therapy when possible.

PATIENT CARE PROCESS

Patient Care Process for Pneumonia

Image not available.

Collect

  • Patient characteristics (eg, age, sex, pregnancy, drug allergies)

  • Patient medical history including comorbid conditions, previous infections, previous hospitalization, and current or recent residence in a nursing facility

  • Social history (including tobacco/ethanol/drug use)

  • Current and past medications, particularly antimicrobials, immune suppressants, and chemotherapy

  • Subjective data

    • Patient-reported risk factors for pneumonia (Table 125-5)

    • Patient-reported pneumonia signs/symptoms (Table 125-7)

    • Timing/location of symptom onset (ie, community vs hospital; time since onset)

  • Objective ...

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.