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
Confusion?
Urea ›7mmol/L?
Respiratory Rate ≥30?
sBP<90 or dBP≤60mmHg?
Age ≥65yrs?
| 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