Acute Bacterial Pneumonia

Chapter 20 Acute Bacterial Pneumonia





1 Define severe community-acquired pneumonia (CAP)


Patients with severe CAP have a number of characteristics:



Unfortunately, it is challenging to prospectively identify this cohort of patients. Of particular concern are patients who are initially triaged as having nonsevere CAP but subsequently need ICU admission (up to 50% of ICU admissions fall under this category in some studies). Such patients tend to have a higher mortality than equally sick patients who have been directly admitted to an ICU. A number of severity of illness scores have been developed to help define severe CAP, a popular one being derived from the joint Infectious Diseases Society of America–American Thoracic Society guidelines for the management of CAP in adults (Box 20-1), which incorporates elements of the confusion, urea, respiratory rate, and blood pressure (CURB) score. By this definition, patients with one major criterion or three minor criteria are designated as having severe CAP. Another widely used score is the Pneumonia Severity Index (PSI). However, none of these scores has been prospectively validated for individual patients. Clinical judgment remains critical; do not blindly follow scores! In recent years other approaches have been explored to identify patients with severe CAP; some of these are discussed below (see answer 9 on recent developments in CAP).






4 What determines the selection of empiric antimicrobial therapy for patients with severe CAP?


The initial empiric antibiotic regimen for patients in the ICU with severe CAP is outlined in Box 20-2. Broadly speaking, the general principles of antibiotic therapy are as follows:





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Jul 7, 2016 | Posted by in CRITICAL CARE | Comments Off on Acute Bacterial Pneumonia

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