Fast Five Quiz: Pneumonia Practice Essentials

Michael Stuart Bronze, MD


November 03, 2021

Although sputum and blood cultures were previously primarily recommended for patients with severe disease, the 2019 ATS/IDSA guidelines recommend they be obtained in all inpatients with CAP who are empirically treated for methicillin-resistant Staphylococcus aureus (MRSA) or P aeruginosa.

At least one major criterion or three minor criteria define the presence of severe CAP. Major criteria include septic shock with the need for vasopressors and respiratory failure requiring mechanical ventilation. Minor criteria include the following:

  • Respiratory rate ≥ 30 breaths/min

  • PaO2/FiO2 ratio ≤ 250

  • Multilobar infiltrates

  • Confusion/disorientation

  • Uremia (blood urea nitrogen level ≥ 20 mg/dL)

  • Leukopenia (white blood cell count < 4000 cells/μL)

  • Thrombocytopenia (platelet count < 100,000/μL)

  • Hypothermia (core temperature < 96.8°F [36°C])

  • Hypotension requiring aggressive fluid resuscitation

The guidelines recommend against use of corticosteroids; however, they may be considered in patients with refractory septic shock. The ATS/IDSA guideline also recommend against obtaining routine follow-up chest imaging. If patients are eligible for lung cancer screening, that should be performed as clinically indicated.

Read more on the workup of CAP.


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