Bacterial Pneumonia Questions & Answers

Updated: Jun 06, 2019
  • Author: Justina Gamache, MD; Chief Editor: Guy W Soo Hoo, MD, MPH  more...
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Questions & Answers

Overview

What is bacterial pneumonia?

What are the symptoms of bacterial pneumonia, and which pathogens may be involved?

What are the signs of bacterial pneumonia?

What are physical findings in bacterial pneumonia?

Which exam findings may indicate a specific etiology for bacterial pneumonia?

Which assessments are used to evaluate the severity of bacterial pneumonia?

When should a sputum Gram stain be performed in the workup of bacterial pneumonia?

Which imaging studies are used in the diagnosis of bacterial pneumonia?

What is the role of bronchoscopy in the diagnosis of bacterial pneumonia?

When is a thoracentesis used in the diagnosis of bacterial pneumonia?

Which pathogen-specific tests are used in the diagnosis of bacterial pneumonia?

What information does histology provide in the diagnosis of bacterial pneumonia?

What is the role of antibiotics in the treatment of bacterial pneumonia?

What supportive measures are used in the treatment of bacterial pneumonia?

How is bacterial pneumonia defined?

What is community-acquired pneumonia (CAP)?

What is aspiration pneumonia?

What causes bacterial pneumonia?

What are the distinguishing characteristics of bacterial pneumonia?

How is the anatomic or radiologic distribution of bacterial pneumonia characterized?

Which environmental settings are associated with bacterial pneumonia?

What is institutional-acquired pneumonia (IAP), and what are the risk factors for healthcare-associated pneumonia (HCAP)?

What is nursing home-acquired pneumonia (NHAP)?

What are the atypical signs commonly seen in nursing home patients with bacterial pneumonia?

What are the IDSA and ATS guidelines on the classification of bacterial pneumonia?

What is nosocomial pneumonia?

What is hospital-acquired pneumonia (HAP), and what are the risk factors?

What is ventilator-associated pneumonia (VAP), and how common is it?

What are the risk factors for aspiration pneumonia?

What causes an increased risk of aspiration and bacterial pneumonia in critically ill patients?

Which bacteria are associated with aspiration pneumonia?

What causes the development of bacterial pneumonia?

What is the pathophysiology of bacterial pneumonia?

What is the effect of acute inflammation during pulmonary infection?

What are the mechanisms that increase virulence in bacterial pneumonia?

What are the organism-specific virulence factors of Streptococcus pneumoniae and Pseudomonas aeruginosa in bacterial pneumonia?

What deficiencies in host defenses can predispose a patient to bacterial pneumonia?

What is the role of viral infection in bacterial pneumonia?

What are the effects of interactions between viruses and bacteria in bacterial pneumonia?

Which pathogens mostly commonly cause bacterial pneumonia?

What are the risk factors for bacterial pneumonia?

Which gram-positive bacteria can cause bacterial pneumonia?

Which gram-negative bacteria can cause bacterial pneumonia?

Which atypical organisms can cause bacterial pneumonia?

Which anaerobic organisms can cause bacterial pneumonia?

What are the most common etiologies of community-acquired pneumonia (CAP) in the hospital setting?

How common are acute lower respiratory tract infections?

What is the incidence of pneumonia in the US?

What are the most common etiologies of community-acquired pneumonia (CAP) in the outpatient setting?

What are the most common etiologies of community-acquired pneumonia (CAP) in ICU?

How common is ventilator-associated pneumonia (VAP) and what is the mortality rate?

What are the race-related demographics of bacterial pneumonia?

What are the sex-related demographics of bacterial pneumonia?

What are the age-related demographics and mortality rates of bacterial pneumonia?

What is the prognosis of bacterial pneumonia, and which factors contribute to increased morbidity and mortality?

What is the risk of mortality in bacterial pneumonia?

What is the microbial etiology of mortality in bacterial pneumonia?

What morbidities are associated with bacterial pneumonia?

Which preventive measures should be encouraged in patients with bacterial pneumonia?

What patient education information is available on bacterial pneumonia?

Presentation

Which features of the patient’s history should be included in the intake assessment of bacterial pneumonia?

What potential exposures are significant in determining possible etiologies of bacterial pneumonia?

What are the aspiration risk factors that increase the risk of developing secondary bacterial pneumonia?

Which factors other than exposures are important in the evaluation of bacterial pneumonia?

What is the clinical presentation of bacterial pneumonia?

What do the characteristics of the sputum suggest in bacterial pneumonia?

What nonspecific symptoms are common in bacterial pneumonia?

How is pertussis characterized in patients with bacterial pneumonia?

When does pneumonia from H influenzae most commonly occur and who is most affected?

What is the presentation of Legionella pneumonia?

What is Legionella pneumophila?

How can physical exam findings vary in patients with bacterial pneumonia?

What are the signs of bacterial pneumonia?

What are the physical findings in bacterial pneumonia?

Which exam findings are associated with a specific etiology for bacterial pneumonia?

What is the CURB-65 scoring system for the risk stratification of bacterial pneumonia?

Which assessments can be used to determine if outpatient treatment or hospitalization is indicated in community-acquired pneumonia (CAP)?

What are the guidelines for determining the treatment setting for bacterial pneumonia based on the CURB-65 score?

What are the mortality rates for each of the CURB-65 scores in bacterial pneumonia?

What is the pneumonia severity index (PSI) for the risk stratification of bacterial pneumonia?

How are demographic factors scored in the pneumonia severity index (PSI) for bacterial pneumonia?

How are coexisting illnesses scored in the pneumonia severity index (PSI) for bacterial pneumonia?

How are physical exam findings scored in the pneumonia severity index (PSI) for bacterial pneumonia?

How are lab and radiographic findings scored in the pneumonia severity index (PSI) for bacterial pneumonia?

What are the mortality rates for each class of the pneumonia severity index (PSI)?

What are the guidelines on treatment setting based on the pneumonia severity index (PSI) risk class in bacterial pneumonia?

What considerations are important when using indices and scores for risk stratification of bacterial pneumonia?

How accurate are the CURB-65 and pneumonia severity index (PSI) in risk stratification for bacterial pneumonia?

What are the IDSA/ATS criteria for determining the appropriate care setting in community-acquired pneumonia (CAP)?

When is direct admission to an ICU mandated for patients with bacterial pneumonia?

Which biological markers may be used for the diagnosis and prognostication of bacterial pneumonia?

In addition to CURB-65 and pneumonia severity index (PSI), what other scoring models can be used to predict mortality in severe bacterial pneumonia?

How is the SOAR scoring model used to predict 30-day mortality in patients with nursing home-acquired pneumonia (NHAP)?

What other prediction models regarding pneumonia severity and outcomes are currently in development?

What are the potential complications of bacterial pneumonia?

How do parapneumonic effusions and empyema occur in bacterial pneumonia?

DDX

What is the most prevalent causative organism in bacterial pneumonia?

How is a diagnosis of aspiration made in bacterial pneumonia?

When should Legionella pneumonia be considered in the diagnosis of bacterial pneumonia?

Which aspects of disease are important in the evaluation and management of bacterial pneumonia?

How is bacterial pneumonia distinguished from other pulmonary diseases?

Why is the differentiation between community-acquired pneumonia (CAP), healthcare-associated pneumonia (HCAP), hospital-acquired pneumonia (HAP), and other pulmonary pathology important?

Which conditions should be considered in children with symptoms of bacterial pneumonia?

What are the differential diagnoses for Bacterial Pneumonia?

Workup

What is the role of diagnostic testing in suspected bacterial pneumonia?

Which lab values may be associated with Legionella pneumonia?

What is the role of antigen-antibody testing in the workup of Legionella pneumonia?

What is the role of imaging studies in the workup of bacterial pneumonia?

Which lab tests are useful for classifying illness severity and admission decisions in bacterial pneumonia?

What do pulse oximetry findings and C-reactive protein (CRP) levels contribute to the clinical picture of bacterial pneumonia?

What may be indicated by leukocytosis or leukopenia in bacterial pneumonia?

What is the significance of an elevated INR in the workup of bacterial pneumonia?

What is the role of blood cultures in bacterial pneumonia?

What is the role of sputum evaluation in the workup of bacterial pneumonia?

Which sputum specimens are suitable for culture in bacterial pneumonia?

How are sputum samples for stains and cultures obtained in intubated patients with bacterial pneumonia?

What is the role of chest radiography in the workup of bacterial pneumonia?

How are the radiographic findings of lobar pneumonia characterized in bacterial pneumonia?

What are the radiographic findings of S pneumoniae lobar pneumonia?

What are the radiographic findings of aspiration lobar pneumonia?

What are the radiographic findings of K pneumoniae lobar pneumonia?

What are the radiographic findings of Legionella lobar pneumonia?

What is the radiographic appearance of lobar pneumonia?

What are the radiographic findings of bronchopneumonia?

What are the radiographic findings of S aureus pneumonia?

What are the radiographic findings of P aeruginosa pneumonia?

What are radiographic findings of interstitial pneumonia?

What is the role of CT scanning in the diagnosis of bacterial pneumonia?

Which abnormalities cause increased lung opacity on CT scans in bacterial pneumonia?

Which abnormalities cause decreased lung opacity on CT scans in bacterial pneumonia?

What is the role of chest ultrasonography in the workup of bacterial pneumonia?

What is the role of thoracentesis in the workup of bacterial pneumonia?

What pathogen-specific tests are available for the workup of bacterial pneumonia?

How are histologic inflammatory lung changes described in bacterial pneumonia?

How are the stages of inflammatory response in lobar pneumonia characterized?

What are the histologic characteristics of bronchopneumonia?

What are the histologic characteristics of interstitial pneumonia?

How are bronchoscopy and bronchoalveolar lavage (BAL) used in the workup of bacterial pneumonia?

Treatment

What is the first step in the management of bacterial pneumonia?

Which index can be used to guide inpatient care and mortality risk for bacterial pneumonia, and how accurate is it?

When is direct admission to an ICU mandated for the treatment of bacterial pneumonia?

Which patients with bacterial pneumonia must be stabilized before transfer?

What are the treatments for bacterial pneumonia and bronchospasm?

What treatment is used for mild shortness of breath in bacterial pneumonia?

What treatments are available for moderate dyspnea in bacterial pneumonia?

What alternatives to intubation can be used for refractory hypoxemia in bacterial pneumonia?

What is the role of fluid resuscitation in the treatment of bacterial pneumonia?

How is empiric antibiotic therapy used in the treatment of bacterial pneumonia?

What are the guidelines for evaluation and antibiotic treatment of community-acquired pneumonia (CAP)?

What are the guidelines for the treatment of hypotension due to septic shock in bacterial pneumonia?

How effective are corticosteroids in the treatment of bacterial pneumonia?

Is drotrecogin alfa used in the treatment of bacterial pneumonia?

What are the goals of pharmacotherapy for bacterial pneumonia?

What is the role of antimicrobial therapy in the treatment of bacterial pneumonia?

What are the IDSA/ATS treatment guidelines for community-acquired pneumonia (CAP)?

How is an antibiotic agent selected for hospitalized patients in the treatment of bacterial pneumonia?

Which infection should always be considered when evaluating community-acquired pneumonia (CAP)?

How is initial antibiotic therapy selected for hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP)?

How is empiric antibiotic therapy selected for outpatient treatment of bacterial pneumonia?

Which empiric antibiotic therapy is indicated in previously healthy patients with bacterial pneumonia and no exposure to antibiotics within the previous 90 days?

Which empiric antibiotic therapy is indicated in patients with bacterial pneumonia and comorbidities or use of antimicrobials within the last 90 days?

Which empiric antibiotic therapy is indicated in patients with bacterial pneumonia and exposure to antibiotics within the previous 90 days?

What are the CMS and Joint Commission guidelines for initiating empiric antibiotic therapy in inpatients with bacterial pneumonia?

Which empiric antibiotics are indicated in non- ICU or ward patients with bacterial pneumonia?

Which empiric antibiotics are indicated in ICU patients with bacterial pneumonia?

Which empiric antibiotics are indicated in bacterial pneumonia with an increased risk of Pseudomonas infection?

Which empiric antibiotics are indicated in patients with bacterial pneumonia and a greater risk of anaerobic infection?

Which empiric antibiotics are indicated in patients with bacterial pneumonia and suspected MRSA infection?

Why is the prevention of influenza important?

Which supportive measures are indicated in the management of bacterial pneumonia?

When is clinical response to antibiotic therapy evaluated and adjusted in bacterial pneumonia?

When is resolution of pneumococcal pneumonia demonstrated on chest radiography?

What does a lack of response to treatment for bacterial pneumonia suggest?

Which studies are indicated in unresponsive cases of bacterial pneumonia?

What are the guidelines on pneumococcal vaccinations for the prevention of bacterial pneumonia?

How effective are influenza vaccinations in reducing the rate of hospitalization for pneumonia and influenza in elderly persons?

How effective are pneumococcal vaccines in the prevention of bacterial pneumonia, and who is at highest risk for pneumococcal pneumonia?

Which vaccines are effective in the prevention of invasive pneumococcal disease?

What are the recommendations for pneumococcal vaccinations for the prevention of bacterial pneumonia?

What is the role of smoking cessation in the prevention of pneumonia and influenza?

Which strategies are effective in the prevention of nosocomial pneumonia?

Which consultations are recommended in bacterial pneumonia?

What is the recommended follow-up for patients with bacterial pneumonia who are treated as outpatients?

When should patients with bacterial pneumonia have follow-up chest radiography, and which findings indicate the need for further treatment?

How common is lung cancer following bacterial pneumonia?

Medications

What is the mainstay of drug therapy for bacterial pneumonia?

What is the role of glucocorticoids in the treatment of acute bacterial pneumonia?

What is the standard treatment for outpatients with bacterial pneumonia?

What is the standard treatment for bacterial pneumonia in children younger than 5 years?

What is the standard outpatient treatment for mild-to-moderate pneumonias in children?

Who is at risk for H influenzae type B (HIB) infection, and what is the standard outpatient treatment?

What is the role of macrolides in the treatment of bacterial pneumonia?

What are the adverse effects of macrolides in the treatment of bacterial pneumonia?

When are macrolides indicated for the treatment of bacterial pneumonia?

When are parenteral agents indicated in the treatment of bacterial pneumonia?

What are the benefits of using second-generation cephalosporins for the treatment of bacterial pneumonia?

What are the benefits of using third-generation cephalosporins for the treatment of bacterial pneumonia?

How is TMP-SMZ used in the treatment of bacterial pneumonia, and what are the adverse effects?

What is the recommended treatment for a severely ill patient with features of sepsis, respiratory failure, or neutropenia in the setting of bacterial pneumonia?

Which medications in the drug class Antibiotics are used in the treatment of Bacterial Pneumonia?

Which medications in the drug class Glucocorticoids are used in the treatment of Bacterial Pneumonia?

Which medications in the drug class Vaccines are used in the treatment of Bacterial Pneumonia?