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🌱 來自: Diagnostic studies-pneumonia

Reasons for failure to improve on initial treatment of pneumonia

• Insufficient time:
  • may take ≥72 h to see improvement
  • (fever persists >4 d in ~20%)
• Insufficient drug levels for lung penetration
  • eg, vanco trough <15–20 μg/mL
• Resistant organisms or superinfxn:
  • eg, MRSA, Pseudo.;
  • consider bronchoscopy
• Wrong dx:
  • fungal/viral, chemical pneumonitis,
  • PE, CHF, ARDS, DAH, ILD;
  • consider CT
• Parapneumonic effusion/empyema/abscess:
  • if CXR ⊖, consider bedside US or CT.
  • If effusion >1 cm, drain & send fluid pH, gluc, Gram stain & Cx.
• Metastatic infection
  • eg, endocarditis, septic arthritis