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General Medicine

Pneumonia, Bacterial

Jocelyn C. Young, DO, MS and Mohammad Humza Qureshi, MD Reviewed 06/2020
 


BASICS

Bacterial pneumonia is an infection of the pulmonary parenchyma by a bacterial organism. 

DESCRIPTION

Bacterial pneumonia can be classified as the following: 

  • Community-acquired pneumonia (CAP): a...

DIAGNOSIS

HISTORY

  • Fever, chills, rigors, malaise, fatigue

  • Dyspnea

  • Cough, with/without sputum

  • Pleuritic chest pain

  • Myalgias

  • GI symptoms

  • Pediatric patients: lethargy, hypotonia, poor feeding, dry mucus membran...

TREATMENT

MEDICATION

First Line

  • Adults

    • CAP, outpatient

      • No significant differences in efficacy between antibiotic options for adults

      • Previously healthy, no antibiotics in past 3 months

        • Macrolide: Azithromyci...

ONGOING CARE

PATIENT EDUCATION

Smoking cessation, vaccinations 

COMPLICATIONS

Necrotizing pneumonia, respiratory failure, empyema, abscesses, cavitation, bronchopleural fistula, sepsis 

REFERENCES

1
Jain S, Williams DJ, Arnold SR, et al; and CDC EPIC Study Team. Community-acquired pneumonia requiring hospitalization among U.S. children. N Engl J Med.  2015;372(9):835–845.
2
Stern A...

CODES

ICD10

  • J15.9 Unspecified bacterial pneumonia

  • J15.4 Pneumonia due to other streptococci

  • J14 Pneumonia due to Hemophilus influenzae

  • J15.20 Pneumonia due to staphylococcus, unspecified

  • J15.3 Pneumonia du...

CLINICAL PEARLS

  • Bacterial pneumonia can usually be treated empirically based on its classification as CAP or HCAP/HAP/VAP.

  • A severity of illness score is helpful in determining the need for hospitaliza...

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FIGURE 13-5 Classic appearance of a Gram stain of sputum from a patient with pneumococcal pneumonia. The smear shows lancet-shaped diplococci with polymorphonuclear leukocytes, and no other prominent bacterial morphology is present.
FIGURE 13-5 Classic appearance of a Gram stain of sputum from a patient with pneumococcal pneumonia. The smear shows lancet-shaped diploco...
FIG. 11.26. A child with bacterial pneumonia. This radiograph of the chest shows a lobar consolidation and a pleural effusion on the right. Note the meniscus indicating the presence of fluid in the pleural cavity.
FIG. 11.26. A child with bacterial pneumonia. This radiograph of the chest shows a lobar consolidation and a pleural effusion on the right....
FIG. 11.27. Pneumonia with large pleural effusion. This child presented with bacterial pneumonia and respiratory distress, presumed to be caused in part by the large pleural effusion. In the emergency department, a pleural catheter ("pigtail") was placed for drainage, using the Seldinger technique.
FIG. 11.27. Pneumonia with large pleural effusion. This child presented with bacterial pneumonia and respiratory distress, presumed to be c...
FIG. 11.61. Varicella pneumonia. Severe pneumonia developed in this patient shortly after she developed vesicular skin lesions that were positive for varicella-zoster virus by direct fluorescent antibody. Varicella causes a diffuse, miliary pattern.
FIG. 11.61. Varicella pneumonia. Severe pneumonia developed in this patient shortly after she developed vesicular skin lesions that were po...
FIGURE 13-1 Chest radiograph showing homogeneous consolidation involving the right upper and middle lobes. The air spaces of the lobes are filled with liquid.
FIGURE 13-1 Chest radiograph showing homogeneous consolidation involving the right upper and middle lobes. The air spaces of the lobes are...
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