Community Acquire Pneumonia

Question 1

What is a community acquired pneumonia?

Answer 1

Community-acquired pneumonia (CAP) is defined as pneumonia that is acquired outside hospital.

Question 2

What is the difference between a LRTI and CAP?

Answer 2

LRTI is a chest infection with no radiological features.
CAP is a chest infection with radiological features (i.e. CXR/CT/US shows consolidation)

Question 3

What is the difference between a CAP and a HAP?

Answer 3

HAP is a pneumonia acquired after at least 48 hours of admission to hospital or within 10 days of discharge

Question 4

Why do definitions of LRTI, CAP, and HAP matter?

Answer 4

They matter due to each having different likely pathogens. these pathogens will have different antibiotics and different disease trajectory

Question 5

What scoring system do we use for CAP?

Answer 5

CURB 65

CURB65 is a scoring system that works out the mortality of a patient with CAP. This then influences the investigations and management of the patient including antibiotics and location of care

Question 6

What microbiology samples should you send for a CAP?

Answer 6

Depends on the CURB65 score

• Blood cultures are recommended for all patients with moderate and high severity CAP
• Sputum samples should be sent for culture and sensitivity tests from patients with CAP of moderate severity who are able to expectorate purulent samples
• Pneumococcal urine antigen tests should be performed for all patients with moderate or high severity CAP
• Legionella Urine antigen tests are recommended for all patients with high severity CAP
• Consider atypical pathogen screen and viral screen also depending on clinical context

Question 7

When do you escalate to your Medical Reg/Consultant for a CAP?

Answer 7

Pragmatically:
- Septic shock
- Severe hypoxia (Fi02 60% or more)
- Not responding to treatment
- Pneumonia with pleural effusion (could this be a pleural infection)

Question 8

What are the criteria’s for CPAP or HFNO (AIRVO)?

Answer 8

Depends on your place of work but usually when FiO2 is greater than 60% they will need HFNO or CPAP

Question 9

What do you need to think about with CAP and an effusion?

Answer 9

Pleural Infection/Pleural empyema

Question 10

What we need to do on discharge for a CAP?

Answer 10

All CAP who are fit enough for follow up should have a follow up CXR in 6-8 weeks