Guidelines
Community Acquired Pneumonia

Community Acquired Pneumonia

Microbiology

Clinical Considerations

  • History of MRSA in previous 12 months, OR
  • Hospitalization with IV antibiotics in previous 90 days

AND at least one of the following:

  • Post-influenza pneumonia
  • Structural lung disease
  • Empyema or lung abscess
  • IV drug use
  • Incarceration
  • History of Pseudomonas aeruginosa in previous 12 months, OR
  • Hospitalization with IV antibiotics in previous 90 days 

AND at least one of the following:

  • COPD
  • Bronchiectasis
  • Structural lung disease

Do NOT add anti-anaerobic therapy for suspected aspiration pneumonia unless lung abscess or empyema is suspected

Strep. Pneumonia resistant to Macrolide >25% in AHZ, don't use as 1st line or monotherapy for CAP

Consider the Procalcitonin pathway

Risk Assessment

Major risk factors (2 points)

  • Antibiotic use < 60 days
  • Long term care facility resident
  • Tube feeding
  • Prior MDR-Pseudomonas within last 1 yr

Minor risk factors (1 point)

  • Hospitalization within 60 days
  • Chronic pulmonary disease
  • Poor functional status
  • Gastric acid suppression (H2 blockers or PPI)

Scores < 4 were associated with lower risk of drug-resistant pneumonia

  • Confusion
    • No = 0
    • Yes = +1
  • BUN > 19 mg/dL (> 7 mmol/L)
    • No = 0
    • Yes = +1
  • Respiratory Rate ≥ 30
    • No = 0
    • Yes = +1
  • Systolic BP < 90 mmHg or Diastolic BP ≤ 60 mmHg
    • No = 0
    • Yes = +1
  • Age ≥ 65
    • No = 0
    • Yes = +1

More Information

Metlay JP, Waterer GW, Long AC, Anzueto A, Brozek J, Crothers K, Cooley LA, Dean NC, Fine MJ, Flanders SA, Griffin MR, Metersky ML, Musher DM, Restrepo MI, Whitney CG. Diagnosis and Treatment of Adults with Community-acquired Pneumonia. An Official Clinical Practice Guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med. 2019 Oct 1;200(7):e45-e67. doi: 10.1164/rccm.201908-1581ST. PMID: 31573350; PMCID: PMC6812437.