Community-acquired pneumonia (CAP): acute infection acquired outside of hospital or within 48 hours of admission
Last revised March 2020
Last updated March 2020
CRB-65: Patient Criteria | Points |
---|---|
Confusion (either based on specific mental test OR new disorientation to person, place or time) | 1 |
Respiratory rate > 30 breaths per minute | 1 |
Hypotension (systolic < 90 mm Hg OR diastolic < 60 mm Hg) | 1 |
Age > 65 years old | 1 |
⇩
CRB-65 Score | 30 Day Mortality | Management Setting |
---|---|---|
0 points AND O2 sat > 92% (on room air) | 2.4 % (low risk) | Outpatient treatment |
1 – 2 points | 13.3 % (moderate risk) | Consider admission to inpatient ward |
3 – 4 points | 34.3 % (high risk) | Often requires an ICU admission |
Last reviewed March 2020
Last reviewed March 2020
*May require renal dose adjustments. Please see Nova Scotia Health Firstline app Note: amoxicillin/clavulanate unnecessarily broad for most community acquired pneumonia in previously healthy individuals. |
Last reviewed June 2023
Usual duration is 5 days, exceptions include:
Last reviewed March 2020
Last reviewed March 2020
1. Jain S, Self WH, Wunderink RG, Fakhran S, Balk R, Bramley AM, et al. Community-Acquired Pneumonia Requiring Hospitalization among U.S. Adults. N Engl J Med. 2015; 373;5: pp 415-427.
2. Metlay JP, Waterer GW, Long AC, Anzueto A, Brozek J, Crothers K, et al. Diagnosis and Treatment of Adults with Community-acquired Pneumonia. Am J Respir Crit Care Med. 2019; Vol 200 (Iss 7): pp 809-821.
3. National Institute for Health and Care Excellence. Pneumonia (community-acquired): antimicrobial prescribing. NICE Guideline. 2019. www.nice.org.uk/guidance/ng138. Accessed September 18, 2019
4. Antibiotics Why and Why Not 2018 Dalhousie CPD Academic Detailing Service, November 2018. http://www.medicine.dal.ca/departments/core-units/cpd/programs/academic-detailing-service.html. Accessed August 12, 2019
5. Management of Community Acquired Pneumonia in Adults. SHS + UHN Antimicrobial Stewardship Program, 2018. https://www.antimicrobialstewardship.com/community-acquired-pneumonia. Accessed August 19, 2019.
Last reviewed March 2020
Hospital-acquired pneumonia (HAP): pneumonia not present at the time of hospital admission and occurring ≥ 48 hours after admission
Last reviewed April 2020
Last reviewed April 2020
Last reviewed April 2020
Last reviewed April 2020
Last reviewed April 2020
Risk Factors | Regimen |
---|---|
|
Ceftriaxone 1 g IV q24h OR Amoxicillin-clavulanate* 875 mg PO BID OR Levofloxacin* 750 mg PO/IV q24h |
Any ONE of the following:
|
Piperacillin-tazobactam* 4.5g IV q6h† OR Meropenem* 500 mg IV q6h Preferred if: colonized/infected with piperacillin-tazobactam resistant microorganism OR IgE mediated penicillin allergy |
If MRSA suspected:
|
ADD: Vancomycin* IV (See NSHA Antimicrobial Handbook or Spectrum App) |
*May require renal dose adjustments, see NSHA Spectrum app or dosing table
†Critical care may have a prolonged infusion protocol
Last reviewed April 2020
1. Kalil AC, Metersky ML, Klompas M, Musced-ere J, Sweeney DA, Palmer LB, et al. Management of Adults With Hospital-Acquired and Ventilator-Associated Pneumonia: 2016 Clinical Practice Guidelines by the Infectious Diseases Society of America and the American Thoracic Society. Clin Infect Dis. 2016; 63: pp e61-e111.
2. National Institute for Health and Care Excellence. Pneumonia (hosptial-acquired): antimicrobial prescribing. NICE Guideline. 2019. www.nice.org.uk/guidance/ng138. Accessed March 13, 2020.
3. Management of Hospital-Acquired Pneumonia in Adults. SHS + UHN Antimicrobial Stewardship Program, 2018. https://www.antimicrobialstewardship.com/community-acquired-pneumonia. Accessed March 13, 2020.
4. Treatment Guidelines. Sunnybrook Health Sciences Centre. https://sunnybrook.ca/content/?page=antimicrobial-stewardship-treatment-guidelines. Accessed April 5, 2020.
Last reviewed April 2020
Ventilator-associated pneumonia (VAP): pneumonia occurring ≥ 48 hours after mechanical ventilation
Last reviewed April 2020
Last reviewed April 2020
Last reviewed April 2020
Last reviewed April 2020
Last reviewed April 2020
Considerations | Regimen |
---|---|
First Line |
Piperacillin-tazobactam* 4.5g IV q6h† OR Meropenem* 500 mg IV q6h Preferred if: colonized/infected with piperacillin-tazobactam resistant microorganism OR IgE-mediated penicillin allergy |
If MRSA suspected:
|
Add Vancomycin* IV |
1. Kalil AC, Metersky ML, Klompas M, Musced-ere J, Sweeney DA, Palmer LB, et al. Management of Adults With Hospital-Acquired and Ventilator-Associated Pneumonia: 2016 Clinical Practice Guidelines by the Infectious Diseases Society of America and the American Thoracic Society. Clin Infect Dis. 2016; 63: pp e61-e111.
2. National Institute for Health and Care Excellence. Pneumonia (hosptial-acquired): antimicrobial prescribing. NICE Guideline. 2019. www.nice.org.uk/guidance/ng138. Accessed March 13, 2020.
3. Ventilator-Associated Pneumonia. SHS + UHN Antimicrobial Stewardship Program, 2020. https://www.antimicrobialstewardship.com/community-acquired-pneumonia. Accessed March 13, 2020.
Last reviewed April 2020