PulmCrit
PulmCrit - October 19, 2019 - By Josh Farkas
"So, the new IDSA guidelines for community acquired pneumonia (CAP) are here. This post will walk us through the guidelines, focusing primarily on issues that relate to critically ill patients. Guidelines can get dull, I've added in GIFs to illustrate my feelings about each recommendation & kept things pretty informal. Come for the GIFs, stay for the medicine.
- Q1: Should gram stain and culture be obtained?
- Q2: Should blood cultures be obtained at time of diagnosis?
- Q3: Should we test for urinary legionella & pneumococcal antigens?
- Q4: Should we test for influenza?
- Q5: “should serum procalcitonin plus clinical judgement versus clinical judgement alone be used to withhold initiation of antibiotic therapy”
- (Q6: this has nothing to do with ICU)
- Q7: Should a clinical prediction rule for prognosis plus clinical judgement versus clinical judgement alone be used to determine triage to ward vs higher intensity unit (e.g. ICU or step-down)?
- (Q8, 9.1: nothing to do with ICU)
- Q9.2: Recommended antibiotics for severe CAP without risk factors for MRSA or pseudomonas?
- Q10: In the inpatient setting, should patients with suspected aspiration pneumonia receive additional anaerobic coverage beyond standard empiric treatment for CAP?
- Q11: In the inpatient setting, should adults with CAP and risk factors for MRSA or pseudomonas be treated with extended-spectrum antibiotic therapy instead of standard CAP regimens?
- Q12: In the inpatient setting, should adults with CAP be treated with corticosteroids?
- Q13: In adults with CAP who test positive for influenza, should treatment regimen include antiviral therapy?
- Q14: In adults with CAP who test positive for influenza, should the treatment regimen include antibacterial therapy?
- Q15: In outpatient and inpatient adults with CAP who are improving, what is the appropriate duration of antibiotic therapy?"