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Community-Acquired Pneumonia

Critical Issues in the Management of Adult Patients Presenting to the Emergency Department With Community-Acquired Pneumonia (November 2009)

Scope of Application

This guideline is intended for physicians working in hospital-based emergency departments.

Inclusion Criteria

This guideline is intended for patients 18 years of age or older with signs and symptoms of CAP and radiographic evidence of pneumonia.

Exclusion Criteria

This guideline is not intended for patients who are pregnant, or immunocompromised (including patients with HIV/AIDS, organ transplant, or recipients of corticosteroids, antineoplastic therapy, or other immunosuppressive agents), or have been hospitalized within the last 30 days.

 

Critical Questions

  • Are routine blood cultures indicated in patients admitted with CAP?

    Recommendations
    Level A Recommendations
    None specified.
    Level B Recommendations
    Do not routinely obtain blood cultures in patients admitted with CAP.
    Level C Recommendations
    Consider obtaining blood cultures in higher-risk patients admitted with CAP (eg, severe disease, immunocompromise, significant comorbidities, or other risk factors for infection with resistant organisms).
    Level A Recommendations
    None specified.
    Level B Recommendations
    Do not routinely obtain blood cultures in patients admitted with CAP.
    Level C Recommendations
    Consider obtaining blood cultures in higher-risk patients admitted with CAP (eg, severe disease, immunocompromise, significant comorbidities, or other risk factors for infection with resistant organisms).
  • In adult patients with CAP without severe sepsis, is there a benefit in mortality or morbidity from the administration of antibiotics within a specific time course?

    Recommendations
    Level A Recommendations

    None specified.

    Level B Recommendations

    There is insufficient evidence to establish a benefit in mortality or morbidity from antibiotics administered in less than 4, 6, or 8 hours from ED arrival.

    Level C Recommendations

    Administer antibiotics as soon as feasible once the diagnosis of CAP is established; there is insufficient evidence to establish a benefit in morbidity or mortality from antibiotics administered within any specific time course.

    Level A Recommendations

    None specified.

    Level B Recommendations

    There is insufficient evidence to establish a benefit in mortality or morbidity from antibiotics administered in less than 4, 6, or 8 hours from ED arrival.

    Level C Recommendations

    Administer antibiotics as soon as feasible once the diagnosis of CAP is established; there is insufficient evidence to establish a benefit in morbidity or mortality from antibiotics administered within any specific time course.

Download the Policy

PDF Icon cp-Pneumonia.pdf April 2018

Findings and Strength of Recommendations

Clinical findings and strength of recommendations regarding patient management were made according to the following criteria:
Level A recommendations
Generally accepted principles for patient care that reflect a high degree of clinical certainty (eg, based on evidence from 1 or more Class of Evidence I or multiple Class of Evidence II studies).
Level B recommendations
Recommendations for patient care that may identify a particular strategy or range of strategies that reflect moderate clinical certainty (eg, based on evidence from 1 or more Class of Evidence II studies or strong consensus of Class of Evidence III studies).
Level C recommendations
Recommendations for patient care that are based on evidence from Class of Evidence III studies or, in the absence of adequate published literature, based on expert consensus. In instances in which consensus recommendations are made, “consensus” is placed in parentheses at the end of the recommendation.
There are certain circumstances in which the recommendations stemming from a body of evidence should not be rated as highly as the individual studies on which they are based. Factors such as heterogeneity of results, uncertainty about effect magnitude, and publication bias, among others, might lead to a downgrading of recommendations.
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