Moffitt AM Report Pearls 6/29: anaerobic coverage, parapneumoic effusion vs empyema

Anaerobic coverage for pulmonary infection

  • Not needed in run-of-the-mill CAP, unless higher concern for classic aspiration situation (e.g. EtOH, seizure etc.)
  • Bugs to consider: Fusobacterium, Prevotella sp, Peptostreptococcus, Bacteroides. These are difficult to isolate in culture, but can be present in 36-76% of empyemas depending on the study
  • Antibiotics to use in anaerobic PNA (according to IDSA): extended-spectrum beta-lactamase, clindamycin, carbapenems
  • Do cephalosporins cover anaerobes? Variable, but should definitely not be your go-to if seriously concerned about anaerobes. According to the Sanford Guide, CTX is indeed better than cefepime as discussed in morning report.

Clinical Pearl: Think about MRSA in MSM patients!

Parapneumonic effusion vs empyema

Check out this helpful table from UpToDate based on the ACCP guidelines.

  • Uncomplicated parapneumonic effusion = category 1 + 2
  • Complicated parapneumonic effusion = category 3
  • Empyema = category 4

Pleural effusions

Evernote link: http://www.evernote.com/l/APjB8_DWM1BNdKBVlwl9PVjh74jNGgX_Jl4/

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