Pneumonia regi

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Pneumonia presentation for intensive care and hospital based

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Pneumonia regi

  1. 1. Regi Septian
  2. 2.  Pneumonia is an inflammatory condition of the lung—affecting primarily the microscopic air sacs known as alveoli. It is usually caused by infection with viruses or bacteria and less commonly other microorganisms, certain drugs and other conditions such as autoimmune diseases.[1][3]  Typical symptoms include a cough, chest pain, fever, and difficulty breathing.
  3. 3.  Globally, pneumonia affects approximately 450 million people per year, seven percent of population, and results in about 4 million deaths, mostly in third world countries.  Although pneumonia was regarded by William Osler in the 19th century as "the captain of the men of death",[5] the advent of antibiotic therapy and vaccines in the 20th century  improvements in survival.  In developing countries, and among the very old, the very young and the chronically ill, pneumonia remains a leading cause of death.
  4. 4. CDC definition of pneumonia Horan TC, Andrus M, Dudreck MA. CDC/NHSN surveillance definition of health-care associated infection and criteria for specific types of infection in the acute care setting
  5. 5. Classification • Pneumonia yang berkembang di luar rumah sakit Community Acquired Pneumonia (CAP) • Pneumonia yang berkembang di luar rumah sakit, pasien yang dirawat dalam perawatan akut, selama 2 hari atau lebih karena infeksi dalam waktu 90 hari terakhir; tinggal di panti wreda / fasilitas perawatan jangka panjang lainnya; menerima terapi antibiotik IV, kemoterapi / perawatan luka dalam waktu 30 hari terakhir/ mendapatkan hemodialisis baik diklinik maupun RS Healthcare Associated Pneumonia (HCAP) • Pneumonia yang berkembang setelah 48 jam setelah masuk rumah sakit dan tidak dalam masa inkubasi pada saat pasien masukHospital Acquired Pneumonia (HAP) • Pneumonia yang timbul dalam waktu 48-72 jam setelah inkubasi endotrakealVentilator Associated Pneumonia (VAP)
  6. 6. Area of The Lung Affected Pneumonia Lobaris • Biasanya mencakup keseluruhan lobus secara homogen • Terdapat 4 tahapan : kongesti, red hepatization, grey hepatization, resolusi Bronkhopneumonia • Konsolidasi “bercak” yang mencakup satu atau beberapa lobus, biasanya mencakup bagian inferior dan posterior paru—pola yang sesuai dengan distribusi aspirasi orofaring akibat gravitasi. Pneumonia interstitialis • Proses inflamasi (bercak atau difusa) mencakup interstitial secara dominan, termasuk, dinding alveolus dan jaringan ikat di sekitar bronchovascular tree. • Alveoli tidak mengandung eksudat, melainkan membran hialin kaya protein (mirip dengan ARDS) Pneumonia milier • Gambaran lesi berukuran 2-3 cm, difus, menyerupai tuberkulosis milier. • Diakibatkan oleh penyebaran patogen ke paru melalui aliran darah
  7. 7. Pneumonia Severity Scores  CURB-65
  8. 8. Pneumonia Severity Index
  9. 9. Clinical Pulmonary Infection Score
  10. 10. Cause  Bacteria  Streptococcus pneumoniae isolated in nearly 50% of cases  Haemophilus influenzae in 20%  Chlamydophila pneumoniae in 13%,  Mycoplasma pneumoniae in 3%  Staphylococcus aureus  Moraxella catarrhalis  Legionella pneumophila  gram-negative bacilli.
  11. 11.  Viruses  Rhinoviruses  Coronaviruses  influenza virus  respiratory syncytial virus (RSV)  Adenovirus  Parainfluenza  Herpes simplex virus is a rare cause of pneumonia, except in newborns  People with weakened immune systems are at increased risk of pneumonia caused by cytomegalovirus (CMV).
  12. 12.  Fungi  Histoplasma capsulatum  Blastomyces  Cryptococcus neoformans  Pneumocystis jiroveci  Coccidioides immitis. • Parasites  Toxoplasma gondii  Strongyloides stercoralis  Ascariasis
  13. 13. Imaging  X-ray  bacterial community acquired pneumonia  lung consolidation of one lung segmental lobe  Aspiration pneumonia bilateral opacities primarily in the bases of the lungs and on the right side
  14. 14. Differential diagnosis  chronic obstructive pulmonary disease (COPD)  Asthma  pulmonary edema  Bronchiectasis  lung cancer  pulmonary emboli
  15. 15. Management  Hospitalization  Antibiotics  Cephalosporins  Carbapenems  Fluoroquinolones  Aminoglycosides  Vancomycin • Antiviral  Neuraminidase inhibitors  Rimantadine,amantadine  Influenza A  oseltamivir, zanamivir or peramivir  Influenza A or B  Rest  simple analgesics  fluids
  16. 16. Prevention of Health Care 1. Staff education and Involvement in Infection Prevention 2. Infection and microbiologic surveillance 3. Prevention of transmission of microorganisms - Sterilization or desinfection & maintance of equipment & devices - Prevention of person to person transmission of bacteria 4. Modifying host risk for infection - Increasing host defense against infection: administration of immune modulators - Precautions for prevention of aspiration - Prevention of postoperative pneumonia - Other prophylactic procedures for pneumonia
  17. 17. Treatment American Thoracic Society, Infectious Diseases Society of America. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare- associated pneumonia.
  18. 18. Treatment- Early onset VAP with no risk factors, any disease severity American Thoracic Society, Infectious Diseases Society of America. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia.
  19. 19. Treatment- Late onset or risk factors for MDR or all disease severity American Thoracic Society, Infectious Diseases Society of America. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia.
  20. 20. Antibiotic Doses Cephalosporin anti-pseudomonal - Cefepime 1-2 g / 8-12 hour - Ceftazidime 2 g/ 8 hour Carbapenem - Imipenem 500 mg/6 hour or 1 g/8 hour - Meropenem 1 g/8 hour Beta Lactam/Inhibitor Beta Lactamase - Piperacillin-tazobactam 4,5 g/6-8 hour Aminoglycoside - Gentamycin 7 mg/kg/day - Tabramycin 7 mg/kg/day - Amikasin 20 mg/kg/day Quinolone-anti-pseudomonal - Levofloxacin 750 mg/day - Ciprofloxacin 400 mg/ 8 hour Vancomycin 15 mg/kg/ 12 hour Linezolid 600 mg/12 hour
  21. 21. Patogen Bacteria MDR  Acinetobacter ( carbapenem, sulbactam,colistin & polymixin)  ESBL enterobacteriaceae (Carbapenem)  MRSA ( Vancomycin; alternatif Linezolid)
  22. 22. Complication  Pleural effusion  Empyema  Abscess  Respiratory failure  Need Mechanical ventilation  Circulatory failure  Intrevenous fluids and medications
  23. 23. TERIMA KASIH

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