Community acquired pneumonia resident survival guide
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Chetan Lokhande, M.B.B.S [2]
Definition
A lower respiratory tract infection in a previously normal individual acquired through normal social contact rather than contracting it in a hospital.
Causes
Life Threatening Causes
No life threatening causes have been noted. However, complications of pneumonia could lead to life threatening situations like pleural effusion, lung abscess, bacteremia, septicemia or a secondary infection involving other organ systems.
Common Causes
- Typical Bacteria
- Streptococcus pneumoniae
- Haemophilus influenzae
- Escherichia coli
- Klebsiella pneumoniae
- Pseudomonas aeruginosa
- Atypical Bacteria
- Viruses
| Location | Etiologies of Community-Acquired Pneumonia[1][2][3] |
| ▸ Outpatient | ▸ Streptococcus pneumoniae |
| ▸ Mycoplasma pneumoniae | |
| ▸ Haemophilus influenzae | |
| ▸ Chlamydophila pneumoniae | |
| ▸ Influenza A and B, adenovirus, respiratory syncytial virus, parainfluenza | |
| ▸ Inpatient (non-ICU) | ▸ Streptococcus pneumoniae |
| ▸ Mycoplasma pneumoniae | |
| ▸ Chlamydophila pneumoniae | |
| ▸ Haemophilus influenzae | |
| ▸ Legionella | |
| ▸ Aspiration | |
| ▸ Influenza A and B, adenovirus, respiratory syncytial virus, parainfluenza | |
| ▸ Yersinia enterocolitica | |
| ▸ Inpatient (ICU) | ▸ Streptococcus pneumoniae |
| ▸ Staphylococcus aureus | |
| ▸ Legionella | |
| ▸ Gram-negative bacilli | |
| ▸ Haemophilus influenzae | |
| ▸ Acinetobacter baumannii |
Management
Please find below an algorithm that summarizes the approach to community acquired pneumonia.
Do's
- Provide coverage for Streptococcus pneumoniae and atypical bacteria like (Mycoplasma, Chlamydophila, Legionella ).[4]
- Perform aggressive fluid resuscitation, prompt antibiotic initiation, measure arterial blood gas in patients who have borderline hypoxemia or lactate.[5]
- Treat co-existing illness like asthma and COPD with bronchodilators.
- Start empirical therapy with coverage for Pseudomonas aeruginosa and MRSA if patient is hospitalized for more than 2 days.[6]
- Give high priority to patients with elevated blood urea nitrogen (BUN), confusion and high respiratory rate.[7]:
- First antibiotic dose should be administered within 6 hours of admission into the emergency room.[8]
- Shock is an exception where antibiotic should be started within an hour of hypotension. A decrease in 8% of survival rate for each hour of delay is noted.[9]
- Treat with antibiotics for atleast 5-7 days.
Dont's
References
- ↑ Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC, Dowell SF, File TM, Musher DM, Niederman MS, Torres A, Whitney CG (2007). "Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults". Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America. 44 Suppl 2: S27–72. doi:10.1086/511159. PMID 17278083. Unknown parameter
|month=ignored (help) - ↑ Wong, KK.; Fistek, M.; Watkins, RR. (2013). "Community-acquired pneumonia caused by Yersinia enterocolitica in an immunocompetent patient". J Med Microbiol. 62 (Pt 4): 650–1. doi:10.1099/jmm.0.053488-0. PMID 23242642. Unknown parameter
|month=ignored (help) - ↑ Oh, YJ.; Song, SH.; Baik, SH.; Lee, HH.; Han, IM.; Oh, DH. (2013). "A case of fulminant community-acquired Acinetobacter baumannii pneumonia in Korea". Korean J Intern Med. 28 (4): 486–90. doi:10.3904/kjim.2013.28.4.486. PMID 23864808. Unknown parameter
|month=ignored (help) - ↑ "MMS: Error".
- ↑ Rivers, E.; Nguyen, B.; Havstad, S.; Ressler, J.; Muzzin, A.; Knoblich, B.; Peterson, E.; Tomlanovich, M. (2001). "Early goal-directed therapy in the treatment of severe sepsis and septic shock". N Engl J Med. 345 (19): 1368–77. doi:10.1056/NEJMoa010307. PMID 11794169. Unknown parameter
|month=ignored (help) - ↑ "Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia". Am J Respir Crit Care Med. 171 (4): 388–416. 2005. doi:10.1164/rccm.200405-644ST. PMID 15699079. Unknown parameter
|month=ignored (help) - ↑ Lim, HF.; Phua, J.; Mukhopadhyay, A.; Ngerng, WJ.; Chew, MY.; Sim, TB.; Kuan, WS.; Mahadevan, M.; Lim, TK. (2013). "IDSA/ATS minor criteria aided pre-ICU resuscitation in severe community-acquired pneumonia". Eur Respir J. doi:10.1183/09031936.00081713. PMID 24176994. Unknown parameter
|month=ignored (help) - ↑ Wilson, KC.; Schünemann, HJ. (2011). "An appraisal of the evidence underlying performance measures for community-acquired pneumonia". Am J Respir Crit Care Med. 183 (11): 1454–62. doi:10.1164/rccm.201009-1451PP. PMID 21239689. Unknown parameter
|month=ignored (help) - ↑ Kumar, A.; Roberts, D.; Wood, KE.; Light, B.; Parrillo, JE.; Sharma, S.; Suppes, R.; Feinstein, D.; Zanotti, S. (2006). "Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock". Crit Care Med. 34 (6): 1589–96. doi:10.1097/01.CCM.0000217961.75225.E9. PMID 16625125. Unknown parameter
|month=ignored (help)