CAP 2010 Guidelines

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  • 1. Philippine Clinical PracticeGuidelineson the Diagnosis, EmpiricManagement, and Preventionof Community-acquired Pneumonia(CAP) in Immunocompetent Adults2010 UpdateMarica A. Lazo

2. IntroductionPneumonia is the third leading cause of morbidity (2001) and mortality (1998) in Filipinos based on the Philippine Health Statistics from the Department of Health 3. Introduction Medline search of literature was conducted using search terms Relevant articles were selected 4. Outline of TopicsPart I: Clinical DiagnosisPart II: Chest RadiographyPart III: Site-of-Care DecisionsPart IV: Microbiologic StudiesPart V: TreatmentPart VI: Prevention 5. Part One: Clinical Diagnosis 6. 1. Can CAP be diagnosedaccurately by history and physicalexamination? 7. Community-Acquired Pneumonia lower respiratory tract infection acquired in thecommunity within 24 hours to less than 2 weeks commonly presents with an acute cough,abnormal vital signs of tachypnea (respiratory rate>20 breaths per minute), tachycardia (cardiac rate>100/minute), and fever (temperature >37.8C)with at least one abnormal chest finding ofdiminished breath sounds, rhonchi, crackles, orwheeze 8. 2. Is there any clinical feature thatcan predict CAP caused by anatypical pathogen? 9. Atypical Pathogens Common cause of CAP in all regions of the worldwith a global incidence of 22% Mycoplasma pneumoniae, Chlamydophila pneumoniae,and Legionella Main difference: presence of extrapulmonaryfindings (GI, cutaneous) Suspect Legionella in hospitalized CAP because it isthe most important atypical pathogen in terms ofseverity 10. Part Two: Chest Radiography 11. 3. What is the value of the chestradiograph in the diagnosis ofCAP? 12. CXR may not be routinely done in: Healthy individuals or those with stable co-morbidconditions, and Normal vital signs and physical examinationfindings, and Reliable follow-up can be ensured. 13. 4. What specific views of the chestradiograph should be requested? 14. 5. Are there characteristicradiographic features that canpredict the likely etiologic agentfrom the chest radiograph? 15. 6. How should a clinician interpreta radiographic finding ofpneumonitis? 16. 7. What is the significance of aninitial normal chest radiographin a patient suspected to haveCAP? 17. 8. Should a chest radiograph berepeated routinely? 18. Repeat CXR Low-risk CAP recovering satisfactorily notneeded CAP not clinically improving or shows progressivedisease should be repeated as needed based onclinicians judgement 4-6 weeks after hospital discharge New radiographic baseline Exclude malignancy 19. 9. What is the role of chest CT scanin CAP? 20. Part Three: Site-of-Care Decisions 21. 10. Which patients will needhospital admission? 22. Sepsis Defined as infection plus systemic manifestationsof infection Severe sepsis is defined as sepsis plus sepsis-induced acute organ dysfunction or tissuehypoperfusion Septic shock is defined as sepsis inducedhypotension (SBP of