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