Pneumonia, Community-Acquired

Robert Bettiker, M.D., M.G.A.
Disclosures		Relationship: Yes Honorarium: Speaker's Bureau (GSK, Cubist), Advisory Panel for Gilead

Gregory Mayro, M.D.
Disclosures		The author has no relationships with commercial interests related to the content of the presentation.

The Planners of this activity have no relationships to disclose.

Robert Bettiker, MD, is associate professor of medicine, Section of Infectious Diseases, Temple University Hospital, Philadelphia, Pa. Here, he discusses the pathophysiology, epidemiology, causes and treatment of community acquired pneumonia (CAP)... and describes the use of the Pneumonia Severity Index Rule in management of CAP. Gregory Mayro, MD, is a second year infectious diseases fellow at Temple University Hospital, Philadelphia, PA where he also completed his training in Internal Medicine. He is a graduate of Jefferson Medical College. Current research projects include an investigation of antibiotic utilization for presumed community acquired pneumonia and an analysis of the incidence of opportunistic infections in the post-HAART era. He is also co-authoring a chapter on infections related to traumatic brain injury.

This lecture and the post-test is worth 1.5 credit hours.

The author defines CAP as a lower respiratory tract infection acquired outside of a hospital, nursing home, long term acute care or skilled nursing facility. He describes CAP as the seventh leading cause of death in the US and the leading infectious cause. Treatment guidelines for CAP, he says, are designed to identify risk factors associated with a poor prognosis; and to provide a framework for management.

The pathophysiology of CAP, Dr. Bettiker notes, is most commonly microaspiration and inhalation of pathogens, which are delivered to the lower respiratory tract. And the commonest cause of CAP is Streptococcus Pneumoniae. In addition, Haemophilus influenzae and Moraxella catarrhalis are pathogens associated with CAP. Community Acquired Methicillin Resistant Staphilococcus aureus (CA-MRSA) is an emerging cause of CAP, and the lecture provides treatment options for CA-MRSA, which, says Dr. Bettiker, is more virulent than hospital-acquired MRSA.

Clinical evaluation may include symptom assessment, physical exam, chest x-ray, lab studies, and bronchoscopy. The Pneumonia Severity Index Rule stratifies adults with radiographic evidence of pneumonia into five progressively severe classes. Among the more than 40 slides accompanying this lecture are three showing general treatment guidelines.

The lecture concludes with a list of complications of pneumonia... and a discussion of prevention of CAP through flu vaccination of such at-risk people as healthcare workers and those over 50.