Article Figures & Data
Figures
- Figure 1
Focal lobar pneumonia.
- Figure 2
Diffuse interstitial pneumonia.
Tables
Criteria Points C Confusion 1 U Urea > 7 mmol/L 1 R Respiratory rate > 30 breaths per minute 1 B Systolic blood pressure < 90 mm Hg 1 or diastolic blood pressure < 60 mm Hg 65 Age ≥ 65 1 Level of care required Total score Outpatient 0–1 Inpatient 2 Intensive care 3–5 Based on information in reference 1.
Risk factor Points Demographics Men Age (years) Women Age (years) – 10 Nursing home resident +10 Comorbidities Neoplasm +30 Liver disease +20 Heart failure +10 Stroke +10 Renal failure +10 Physical examination findings Altered mental status +20 Respiratory rate > 30 breaths per minute +20 Systolic blood pressure < 90 mm Hg +20 Temperature < 95°F or > 104°F +15 Heart rate > 125 beats per minute +10 Laboratory and radiographic findings Arterial pH < 7.35 +30 Blood urea nitrogen > 30 mg/dL +20 Sodium < 130 mmol/L +20 Glucose > 250 mg/dL +10 Hematocrit < 30% +10 Partial pressure of arterial oxygen < 60 mm Hg +10 Pleural effusion +10 Risk class Total points I < 51 II 51–70 III 71–90 IV 91–130 V > 130 From Fine MJ, Auble TE, Yealy DM, et al. A prediction rule to identify low-risk patients with community-acquired pneumonia. N Engl J Med 1997; 336(4):243–250. Copyright 1997, Massachusetts Medical Society. Reprinted with permission from the Massachusetts Medical Society..
- TABLE 3
Severe pneumonia: Infectious Diseases Society of America and American Thoracic Society criteria
Major criteria Respiratory distress requiring mechanical ventilation Septic shock Minor criteria Confusion Respiratory rate > 30 breaths per minute Blood urea nitrogen > 7 mmol/L Leukopenia resulting from infection Thrombocytopenia Hypothermia Hypotension requiring aggressive fluids PaO2 / FiO2 < 250 Multilobar infiltrates Having at least 1 major criterion or at least 3 minor criteria suggests the need for intensive care. From Mandell LA, Wunderink RG, Anzueto A, et al; Infectious Diseases Society of America; American Thoracic Society. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis 2007; 44(suppl 2):S27–S72, by permission of Oxford University Press.
Intensive care unit admission Cavitary infiltrates Leukopenia Active alcohol abuse Chronic liver failure Asplenia (anatomic or functional) Positive pneumococcal urine antigen test Pleural effusion Based on information in reference 1.
Outpatient care Streptococcus pneumoniae Mycoplasma pneumoniae Haemophilus influenzae Chlamydophila pneumoniae Respiratory virus (influenza A and B, adenovirus, respiratory syncytial virus, parainfluenza) Inpatient (non-intensive care) S pneumoniae M pneumoniae C pneumoniae H influenzae Legionella species Aspiration-related oral flora Respiratory viruses Inpatient (intensive care) S pneumoniae Staphylococcus aureus Legionella species Gram-negative bacilli H influenzae From Mandell LA, Wunderink RG, Anzueto A, et al; Infectious Diseases Society of America; American Thoracic Society. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis 2007; 44(suppl 2):S27–S72, by permission of Oxford University Press.
Outpatients without comorbiditiesa Amoxicillin Or doxycycline Or a macrolide Outpatients with comorbidities Combination therapy: Amoxicillin/clavulanate or a cephalosporin Plus a macrolide or doxycycline Or monotherapy with a fluoroquinolone Patients on a medical floor A fluoroquinolone Or a combination of a beta-lactam plus a macrolide Intensive care patients A beta-lactam Plus either a macrolide or a fluoroquinolone Add coverage as needed for: Methicillin-resistant Staphylococcus aureus (MRSA) Pseudomonas aeruginosa Influenza A ↵a Comorbidities include heart, lung, liver, or renal disease, diabetes mellitus, alcoholism, malignancy, and asplenia
Based on information from reference 1.
