PG 2025: Pulmonary Literature Review and Interactive Complex Case Presentations (PG)-Restrepo_CAP_Lit

Restrepo_CAP_Lit_RevQA

Pdf Summary

This literature review, led by Dr. Marcos I. Restrepo, presents updated insights on pneumonia diagnosis and management, emphasizing community-acquired pneumonia (CAP), particularly in the context of viral infections like influenza A. <br /><br />A clinical case of a 70-year-old diabetic woman with influenza A and bilateral infiltrates highlights that despite viral confirmation, empiric antibiotic treatment with ceftriaxone and azithromycin is recommended to cover potential bacterial-viral co-infections. Delaying antibiotics or using broader-spectrum agents without risk factors is discouraged. Early antibiotic initiation followed by rapid de-escalation after clinical improvement is advised. Staphylococcus aureus, especially MRSA, is noted as a common co-infecting pathogen in influenza.<br /><br />Key points include: <br />- Streptococcus pneumoniae remains the leading bacterial cause of death in lower respiratory tract infections.<br />- CAP increases the subsequent risk of developing dementia.<br />- Combining metagenomic next-generation sequencing with conventional microbiology can shorten time to clinical improvement in severe CAP.<br />- Strategies using multiplex PCR and serum procalcitonin may reduce antibiotic exposure and improve ICU patient outcomes.<br />- Adding clarithromycin to β-lactam antibiotics may improve outcomes in CAP patients with sepsis.<br />- Empiric antibiotics should be started in hospitalized non-ICU CAP patients even when a respiratory virus is detected.<br />- Antibiotics can be discontinued upon clinical stability by day 3 in non-ICU patients.<br />- Systemic corticosteroids are not routinely recommended for severe CAP with negative influenza.<br />- Lung ultrasound is a viable diagnostic alternative to chest x-ray for suspected CAP when expertise is available.<br /><br />A second case of a 72-year-old man with influenza and respiratory failure illustrates lung ultrasound findings confirming pneumonia and guiding appropriate ICU care.<br /><br />Overall, the review underscores the importance of timely, targeted antibiotic therapy alongside supportive care and evolving diagnostic tools to optimize pneumonia treatment outcomes.

Keywords

community-acquired pneumonia

influenza A

empiric antibiotic treatment

ceftriaxone

azithromycin

Staphylococcus aureus MRSA

metagenomic next-generation sequencing

multiplex PCR

procalcitonin

lung ultrasound