131.3 🩺 內科專科考前版

131.3.0.1 1️⃣ 22E 更新

• 2019 IDSA/ATS CAP Guidelines still current; 2024 ATS HAP/VAP guidelines
• Procalcitonin (PCT) guidance: 在 CAP 可幫助 antibiotic 縮短 (PCT-guided therapy)
• Multiplex PCR (BioFire RP) revolutionizing diagnosis (< 1 hr)
• Cefiderocol, Ceftolozane-tazo for MDR Pseudomonas / CRE pneumonia
• Inhaled antibiotics (colistin, amikacin, gentamicin) adjunct in VAP
• COVID-19: anti-spike monoclonal Ab decreased (variant resistance), Paxlovid + Remdesivir mainstay

131.3.0.2 2️⃣ Diagnostics

• CXR + CT (better sensitivity)
• POCUS lung: B-lines, consolidation
• Microbiology:
  • Sputum Gram + culture (limited sensitivity)
  • Blood culture (low yield ~10%)
  • Urinary antigen: S. pneumoniae, Legionella ser 1
  • Multiplex PCR: respiratory viruses + atypicals
  • BAL/PSB if intubated + culture-negative

131.3.0.3 3️⃣ 台灣 context

• CAP empirical 同 IDSA — ceftriaxone + macrolide
• Macrolide resistance in M. pneumoniae 高 (>40%) → doxy/FQ alternative
• 健保 ICU pneumonia 給付 vancomycin, linezolid, daptomycin (依適應症)
• Penicillin-resistant S. pneumoniae 偏低 (~ 10-20%); MRSA 多 HCA 來源

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