CAP

Refers to pneumonia acquired outside of the hospital setting.

Patients residing in long term care, or those who have frequent exposure to health care facilities (e.g. dialysis centers) should be categorized as having CAP; the term "Health Care-Associated Pneumonia" is no longer used.

A diagnosis of pneumonia generally requires a demonstration of an infiltrate of chest imaging; X-rays may be negative in immunocompromised hosts or severely dehydrated patients

Fever, dyspnea, cough and sputum production comprise clinically compatible symptoms

NP swabs for respiratory viruses (influenza, enterovirus, rhinovirus) are recommended during flu season for CAP

Blood and sputum cultures should be obtained in hospitalized/ED patients; noninvasive sampling is preferred

Procalcitonin of > 0.5 mcg/L (>0.25 mcg/L in ICU patients) has a high positive predictive value for bacterial pneumonia. Antibiotics are discouraged when PCT is negative (<0.25mcg/L)

Legionella urine antigen can be ordered on inpatients if interstitial/atypical X-ray findings or risk factors (hot tub exposure, travel)

Serology (IgM) for mycoplasma is no longer indicated

The Respiratory Pathogen Panel (RPP) tests for 22 different respiratory pathogens by PCR, including atypical organisms and viruses, and can be ordered in patients in the ICU or upon approval from Medical Microbiology

In patients with cavitary pneumonia consider TB, fungal pathogens and Nocardia

In immunocompromised patients consider opportunistic pathogens such as PJP, CMV and fungal pathogens

CRB-65 is a tool to classify pneumonia and estimate severity. It is well correlated with mortality and can be used to make admission decisions. It does not supplant clinical judgement.

One point is given for each:

  • Confusion (new disorientation to person, place or time)

  • Respiratory rate ≥ 30 breaths/min

  • Blood pressure <90mmHg systolic or < 60mmHg diastolic

  • Age ≥ 65 years

CRB-65 Score

Check all that apply:

high severity if either of