Any ≥ 2 of the following are suggestive for CAP:
- fever / hypothermia
- rigors
- sweats
- new / increased cough (± sputum)
- chest discomfort
- new onset dyspnoea
- confusion (especially elderly)
CAP – Investigations:
- FBC, EUC, Glc
- ± CXR – generally patients with normal CXR will not benefit from intravenous antibiotics
- advanced age
- renal / cardiac / CLD / CNS disease / malignancy / immunosuppression
- RR > 30 / SBP < 90 / DBP ≤ 60 / acute confusion
- Os2 saturation < 90%
- bilateral / multilobar involvement on CXR
CAP – Management (basic questions to ask):
- Is it pneumonia?
- How severe is the pneumonia?
- Is hospitalisation appropriate?
- What therapy should be commenced?
- Are there any special considerations?
CAP – pathogens:
- Strep. pneumonia
- Chlamydia pneumoniae
- Chlamydia psittaci
- Mycoplasma pneumoniae
- Haemophilus influenzae
- Moraxella catarrhalis
- respiratory viruses
- less common, but important:
- Legionella spp.
- S. aureus
- Gram negative bacilli
- tropical pathogens (northern Australia)
- Acinetobacter baumannii
- Burkholderia pseudomalle