community_acquired_pneumonia

Community Acquired pneumonia

Causes

Bacterial infection of lung

Symptoms

Fever
Cough
Purulent sputum
Pleuritic chest pain

Signs

Purulent sputum
Fever
Unilateral chest signs (crackles, bronchial breathing, pleural rub) – if bilateral signs reconsider diagnosis

Tests

Blood tests (FBC, U&E, CRP at least)
CXR where diagnosis uncertain or failure to improve

Management

First, calculate the CURB-65 severity score:

CURB65 Score

Score	Risk	Plan
0 or 1	1.5% mortality	Routine care Monitoring not usually required
2	9.2% mortality	Consider need for admission – if remaining at home should be admitted to remote monitoring virtual ward
≥3	22% mortality	Admission recommended (be guided by any existing Urgent Care Plan / treatment escalation plan)

Antibiotics should be prescribed according to the Trust’s antibiotic guidelines.
If recent hospital discharge, consider treating as hospital acquired infection.
Treatment escalation plans (including resuscitation decisions) should be established

When to admit

Pneumonia where CURB65 score ≥3 (unless treatment escalation plan states for home management only)
Cases where there is a requirement for the administration of oxygen
Where there is concern from the assessing clinician (if in doubt discuss with consultant/GP)
Cases where there is failure to improve if ongoing deterioration (consider repeat bloods in community to guide discussions) – can consider suitability for SDEC for x-ray

Author: Dr Chris Bell, Feb 2023