Community-Acquired Pneumonia


Article Author:
Hariharan Regunath


Article Editor:
Yuji Oba


Editors In Chief:
Melissa Max
Danyae Lee
Manouchkathe Cassagnol


Managing Editors:
Orawan Chaigasame
Carrie Smith
Abdul Waheed
Frank Smeeks
Kristina Soman-Faulkner
Benjamin Eovaldi
Radia Jamil
Sobhan Daneshfar
Pritesh Sheth
Hassam Zulfiqar
Steve Bhimji
John Shell
Matthew Varacallo
Ahmad Malik
Mark Pellegrini
James Hughes
Beata Beatty
Hajira Basit
Phillip Hynes
Kavin Sugumar


Updated:
2/11/2019 9:16:38 PM

Introduction

Community-acquired pneumonia is a leading cause of hospitalization, mortality and incurs significant health care costs. As disease presentation varies from a mild illness that can be managed as an outpatient to a severe illness requiring treatment in intensive care unit, determining the appropriate level of care is important for improving outcomes in addition to early diagnosis and appropriate and timely treatment.[1][2][3][4]

Etiology

The pathogens causing community-acquired pneumonia can be classified as two types: (1) Typical agents such as Staphylococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, S. aureus, Group A streptococci, anaerobes, and gram-negative organisms and (2) Atypical agents such as Legionella, Mycoplasma, Chlamydia pneumoniae, and C. psittaci. Influenza and noninfluenza respiratory viruses have been increasingly detected as pathogens depending on the availability of polymerase chain reaction-based detection methods. Worldwide, S. pneumoniae and H. influenzae are the leading causes of bacterial pneumonia. The most common pathogens identified in the most recent population-based active surveillance in the United States were human rhinovirus, influenza virus, and Streptococcus pneumoniae. 

Epidemiology

The estimated worldwide incidence of community-acquired pneumonia varies between 1.5 to 14 cases per 1000 person-years, and this is affected by geography, season, and population characteristics. In the United States, the annual incidence is 24.8 cases per 10,000 adults with higher rates as age increases. Pneumonia is the eighth leading cause of death and first among infectious causes of death. The mortality rate is as high as 23% for patients admitted to the intensive care unit. All patients with comorbid illness are considered at risk for pneumonia, but specific risk factors exist for specific pathogens including (1) Drug-resistant pneumococci - age greater than 65, exposure to children in day care centers, intake of beta-lactam in previous 90 days, alcoholism, chronic medical conditions, immune-suppression; and (2) Pseudomonas - bronchiectasis, malnutrition, corticosteroid therapy, antibiotic intake for greater than 7 days in the preceding month. Other etiological clues from epidemiology include the following: coccidioidomycosis in the Southwestern United States, blastomycosis or histoplasmosis in the states of the Ohio River valley, bird exposures for Chlamydia psittaci, contact with flea-infested or infected rodent or rabbits during outside activities such as lawn mowing in the Northeast US (Martha's Vineyard, Cape Cod, etc) for tularemia pneumonia. 

Pathophysiology

Colonization of the pharynx with pathogens, followed by micro-aspiration is the mechanism of entry into the lower respiratory tract. In the interaction between the pathogen and host pulmonary defense, pneumonia results if there is a defect in host defense or it is overcome by high inoculum or virulence of the pathogen. Hematogenous spread and macro-aspiration are other mechanisms.

History and Physical

Fever, chills, cough productive of purulent sputum, dyspnea, pleuritic chest pain, and weight loss are common symptoms. The elderly, patients with alcoholism, and those who are immune-compromised can have less evident or systemic symptoms such as weakness, lethargy, altered mental status, dyspepsia or other upper gastrointestinal symptoms, and absence of fever. Some manifestations provide etiological clues such as diarrhea, headache and confusion (related to hyponatremia) for Legionella; and otitis media, Stevens-Johnson syndrome, or anemia/jaundice (hemolytic anemia) for Mycoplasma. Pneumonia can result in acute decompensation of underlying chronic illness like congestive heart failure which can confound the initial presentation and result in diagnosis and treatment delays.

Evaluation

A complete blood count with differentials, serum electrolytes, and renal and liver function tests are indicated for confirming evidence of inflammation and assessing severity. A chest x-ray will be needed to identify an infiltrate or effusion, which if present, will improve diagnostic accuracy. In hospitalized patients, blood and sputum cultures should be collected, preferably before the institution of antimicrobial therapy but without delay in treatment. Urine for Legionella and pneumococcal antigens must be considered as they aid in diagnosis when cultures are negative. In the presence of confounding co-morbidities, such as congestive heart failure, serum procalcitonin levels can be used as a biomarker to initiate and guide antimicrobial therapy. Influenza testing is recommended during the winter season. If available, testing for respiratory viruses on nasopharyngeal swabs by molecular methods can be considered. CURB 65 (confusion, urea greater than or equal to 20 mg/dL, respiratory rate greater than or equal to 30/min, blood pressure systolic less than 90 mmHg or diastolic less than 60 mmHg) and Pneumonia Severity Index (PSI) are tools for severity assessment to determine the treatment setting, such as outpatient versus inpatient, but accuracy is limited when used alone or in the absence of effective clinical judgement. Serology for tularemia, endemic mycoses or C. psittaci can be sent in the presence of epidemiologic clues.[5][6][7]

Treatment / Management

For outpatients, monotherapy with a macrolide (erythromycin, azithromycin or clarithromycin) or doxycycline is recommended. In the presence of co-morbid illness (chronic heart disease excluding hypertension; chronic lung disease - COPD and asthma; chronic liver disease; chronic alcoholism; diabetes mellitus; smoking; splenectomy; HIV or other immunosuppression) a respiratory fluoroquinolone (high-dose levofloxacin, moxifloxacin, gemifloxacin) or a combination of oral beta-lactam (high dose amoxicillin or amoxicillin-clavulanate, cefuroxime, cefpodoxime) and macrolide is recommended.[7][8][9][10]

For patients with CURB 65 score of greater than or equal to 2, inpatient management is recommended. A respiratory fluoroquinolone monotherapy or combination therapy with beta-lactam (cefotaxime, ceftriaxone, ampicillin-sulbactam or ertapenem) and macrolide are recommended options for nonintensive care settings.

Admission to the intensive care unit must be considered in patients with three or more signs of early deterioration. These include respiratory rate greater than 30, PaO2/FiO2 less than or equal to 250, multilobar infiltrates, encephalopathy, thrombocytopenia, hypothermia, leucopenia, and hypotension. Combination therapy with a beta-lactam and either a macrolide or a respiratory fluoroquinolone is recommended. In patients with possible aspiration, ampicillin-sulbactam or ertapenem can be used. Monotherapy is not recommended.

If risk factors for pseudomonas are present, then anti-pseudomonal beta-lactam (piperacillin-tazobactam, cefepime, ceftazidime, meropenem, imipenem) along with either an anti-pseudomonal fluoroquinolone (ciprofloxacin or levofloxacin) or a combination of aminoglycoside and azithromycin are recommended. Vancomycin or linezolid should be added if community-acquired methicillin-resistant S. aureus is a consideration. 

The recommended duration of therapy is 5 to 7 days in patients with a favorable clinical response such as the absence of fever for more than 48 to 72 hours, not requiring supplemental oxygen, and resolution of tachycardia, tachypnea, or hypotension. Prolongation of therapy is indicated in patients with a delayed response, certain bacterial pathogens such as Pseudomonas (14 to 21 days) or S. aureus (7 to 21 days) or Legionella pneumonia (14 days), and for complications such as empyema, lung abscess, or necrotizing pneumonia. Chest tube placement will be needed to drain an empyema, and in cases with multiple loculations, a surgical decortication may be needed. A 14-day therapy with macrolide or doxycycline will treat tularemia pneumonia or psittacosis, and itraconazole is the drug of choice for pneumonia caused by coccidioidomycosis or histoplasmosis.

A five-day therapy with oseltamivir is recommended for all patients who test positive for influenza virus. For outpatients with delayed presentation (greater than 48 hours from onset of symptoms), there is no benefit, but any hospitalized patients with influenza must be treated with this agent irrespective of time of presentation from the onset of illness. 

Intravenous glucocorticoids can be considered in critically ill patients with community-acquired pneumonia without risk factors for adverse outcomes from use of steroids (e.g., influenza infection).

Pearls and Other Issues

All adults 65 years and older and those considered at risk for pneumonia must receive the pneumococcal vaccination. There are two vaccines available: PPSV 23 and PCV 13.

Current ACIP recommendations for unvaccinated non-immune-compromised individuals aged 19to 64 years old and at risk for pneumonia, first should receive PPSV 23. After age 65, a dose of PCV 13 can be given (after at least one year of the first dose of PPSV 23), followed by the second dose of PPSV 23 spaced at least one year from PCV 13 and 5 years from the first dose of PPSV 23. For patients who are immune-compromised or asplenic (functional or anatomical) and 19 to 64 years old, first give PCV 13, followed by the first dose of PPSV 23 8 weeks or later and second dose PPSV 23 after 5 years. A booster PPSV 23 can be given for a patient 65 years or older after at least 5 years or longer from the second dose of PPSV 23. 

For all unvaccinated adults 65 years or older, first vaccinate with PCV 13, followed by PPSV 23 at least a year later for patients who are immune competent and at least 8 weeks or more apart for patients who are immune compromised or asplenic.

Influenza vaccination is recommended for all adult patients at risk for complications from influenza. Inactivated flu shots (trivalent or quadrivalent, egg-based or recombinant) are usually recommended for adults. Live attenuated intranasal vaccine can be given to healthy, nonpregnant adults who are less than 49 years old. It is contraindicated in pregnancy, the immune suppressed or health care workers caring for them, and in those with comorbidities.

Enhancing Healthcare Team Outcomes

Patients with community pneumonia may present to the primary care provider, nurse practitioner, or the emergency department. Hence these professionals should be aware of the signs and symptoms. If the diagnosis is not clear cut, then an infectious disease consult is recommended. Most patients do respond to outpatient antibiotic therapy for 5-7 days. Patients who are short of breath, febrile, and in respiratory distress need to be admitted. Some patients may present with a parapneumonic effusion, which may require drainage. The primary care provider and nurse practitioner should encourage all seniors to get the annual flu vaccine. In addition, all adults 65 years and older and those considered at risk for pneumonia must receive the pneumococcal vaccination. The outcomes in most patients with community-acquired pneumonia are excellent. [11](Level V)


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Community-Acquired Pneumonia - Questions

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A 55-year-old homeless man in the emergency department with a 3-day history of low-grade fever, productive cough, rales at the base, chills, and night sweats, appears ill with normal vital signs nd increased fremitus in the left lower chest. What is the next step in treatment?



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A teenager presents to the ER with a sore throat and a dry cough. She has had a low-grade fever for 3 days. She says her classmates have had similar symptoms. Chest radiograph shows a vague ill-defined opacity in the left lower lobe. She has a WBC of 14.6. You think she has a community-acquired pneumonia and prescribe her which drug?



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All of the following are true regarding community acquired pneumonia except:



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Which of the following is true regarding the role of sputum Gram stain and culture in the diagnosis of community-acquired pneumonia?



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An adult female presents with a sore throat and a dry cough. She has had a low-grade fever for 3 days. She says her colleagues at work have had similar symptoms. The chest x-ray is unremarkable. She has a WBC of 14.6/microL. The provider thinks she has community-acquired pneumonia. Which of the following would be the best first choice?



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The majority of cases of community-acquired pneumonia are caused by which of the following microorganisms?



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What is the most common bacteria causing community acquired pneumonia in North America?



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Which of the following is NOT true regarding community acquired pneumonia?



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Which of the following is the most common cause of community-acquired pneumonia?



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Which of the following should not be used for outpatient treatment of community acquired pneumonia in the elderly?



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An adult previously in good health has dyspnea, fever, cough, and pleuritic chest pain. The temperature is 38.2 Celsius and egophony is noted in the left side of the chest. Which of the following is the best treatment?



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The CURB-65 criteria for hospital admission are used to predict the need for hospital admission for patients with community-acquired pneumonia. Which of the following patients should be admitted?



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A 38-year-old smoker with non-ischemia cardiomyopathy (LVEF 45 percent) presents with fever, productive cough, and malaise. On exam, mucous membranes are dry, afebrile, heart rate is 120/min, respiratory rate 30/min, oxygen saturation is 93 percent, blood pressure is 96/60 mmHg, there is mild respiratory distress and bilateral wheezing without egophony or bronchophony. The chest x-ray is reported as "cardiomegaly and no infiltrates". Serum BNP was 250. He is on an angiotensin-converting enzyme inhibitor and furosemide. The EKG has sinus tachycardia and no ST-T changes. Which of the following statements are correct in making a diagnosis of pneumonia?



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A previously healthy 25 year old female presents with community acquired pneumonia. She is febrile, alert, tachypneic with respirations of 26, and a blood pressure of 110/70. Select the most appropriate antibiotic.



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A 65-year-old male smoker is diagnosed with a community-acquired pneumonia. He is febrile, respiratory rate 32/min, alert, and blood pressure 116/80 mmHg. Lab tests show WBC at 15,000 with a left shift. Serum electrolytes are normal, BUN 32 mg/dL and serum creatinine 1.5 mg/dL. Oxygen saturation on room air is 90 percent. Which of the following is the correct answer ?



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A 62 year old female presents with deep productive cough, fever and radiographic evidence of pneumonia. She is alert and oriented with blood pressure 90/52 mm Hg, respirations 22 per minute, and BUN 38 mg/dL. What is her approximate risk of dying from this pneumonia?



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Which of the following is the most common cause of community-acquired bacterial pneumonia in the elderly?



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A previously healthy 17-year-old female presents to the ER with a sore throat and a dry cough. She has had a low-grade fever for 3 days. The chest x-ray is unremarkable. She has a WBC of 15. A community-acquired pneumonia is suspected. Which of the following would be most appropriate?



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Which one of the following organisms is least likely to cause community-acquired pneumonia (CAP)?



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Which of the following is a preferred monotherapy for the outpatient treatment of community-acquired pneumonia (CAP)?



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What is the cause of the majority, 30 to 50 percent, of community-acquired pneumonia (CAP)?



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Which of the following regimens would be appropriate for an inpatient with the diagnosis of community-acquired pneumonia?



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Which of the following is not an empiric outpatient treatment of community-acquired pneumonia?



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Which is the most likely causal organism of community-acquired pneumonia?



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Which of the following statement is correct in regards to severity scores available for community acquired pneumonia?



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A 55 years old HIV positive male with no other comorbidities, developed productive cough and dyspnea for past 3 days. Two weeks ago he was treated with a 5 day course of amoxicillin-clavulanate for sinusitis followed by complete recovery. His 3 year old daughter, who attends day-care center, was treated with amoxicillin 3 weeks ago for otitis media. Because of worsening dyspnea he presented to emergency room. He was febrile, heart rate 110/min, respiratory rate 30/min, oxygen saturation 92 percent on 4L/min of nasal oxygen, lung exam revealed crackles in right lower base. Blood tests show white cell counts were normal with 90% neutrophils and bands 4%, hemoglobin and platelets were normal. Blood urea 22 mg/dL, serum creatinine, electrolytes and liver transaminases were normal. Most recent CD4 count was 300 and HIV viral load 4 months ago was undetectable. Reverse transcription PCR on a nasopharyngeal swab was positive for influenza B. Chest X ray showed bilateral multilobar infiltrates and blunting of right costophrenic angle. Which of the following is the most appropriate treatment plan?



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Among non immunocompromised patients hospitalized with community acquired pneumonia in the United States, which of the following are the most commonly identified etiological agents in the descending order?



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A patient demonstrates symptoms that strongly suggest a diagnosis of community-acquired pneumonia caused by antibiotic-resistant pneumococci. While awaiting definitive results from the lab, empiric therapy must be initiated. Which antimicrobial agent would be the proper initial choice for this empiric therapy?



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A 7-year old is seen in the emergency room with a wet cough, fever, and general malaise. The work-up reveals that he has lobar pneumonia. He has otherwise been healthy, and he has had all his vaccinations to date. Based on the 2011 guidelines released by the Infectious Disease Society of America, the child should be treated with which of the following?



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A 65-year-old male who lives in his own home presents with right-sided chest pain for 2 days, frequent productive cough, fever, shortness of breath, and fatigue. He reports a recent trip to his healthcare provider where he received a prescription for antibiotics to treat bronchitis. The patient states he stopped taking the antibiotics after 2 days, but it was a 5-day course. What results of diagnostic tests or procedures ordered would support the clinical picture? Select all that apply.



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A 68-year-old female has been diagnosed with community-acquired pneumonia by her healthcare provider. What assessment findings correlate with this medical diagnosis and nursing diagnosis of ineffective airway clearance? Select all that apply.



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Forever a procrastinator, a nursing student waits until the absolute last minute to produce a care plan for their medical-surgical clinical rotation. The care plan is for a client with community-acquired pneumonia hospitalized for the first time. What nursing diagnosis correlates with this medical diagnosis? Select all that apply.



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Community-Acquired Pneumonia - References

References

Lu H,Zeng N,Chen Q,Wu Y,Cai S,Li G,Li F,Kong J, Clinical prognostic significance of serum high mobility group box-1 protein in patients with community-acquired pneumonia. The Journal of international medical research. 2019 Feb 7;     [PubMed]
Hassen M,Toma A,Tesfay M,Degafu E,Bekele S,Ayalew F,Gedefaw A,Tadesse BT, Radiologic Diagnosis and Hospitalization among Children with Severe Community Acquired Pneumonia: A Prospective Cohort Study. BioMed research international. 2019;     [PubMed]
Alshahwan SI,Alsowailmi G,Alsahli A,Alotaibi A,Alshaikh M,Almajed M,Omair A,Almodaimegh H, The prevalence of complications of pneumonia among adults admitted to a tertiary care center in Riyadh from 2010-2017. Annals of Saudi medicine. 2019 Jan-Feb;     [PubMed]
Guo Q,Song WD,Li HY,Zhou YP,Li M,Chen XK,Liu H,Peng HL,Yu HQ,Chen X,Liu N,Lü ZD,Liang LH,Zhao QZ,Jiang M, Scored minor criteria for severe community-acquired pneumonia predicted better. Respiratory research. 2019 Jan 31;     [PubMed]
Torres A,Chalmers JD,Dela Cruz CS,Dominedò C,Kollef M,Martin-Loeches I,Niederman M,Wunderink RG, Challenges in severe community-acquired pneumonia: a point-of-view review. Intensive care medicine. 2019 Jan 31;     [PubMed]
Pickens CI,Wunderink RG,Pickens CI, Principles and Practice of Antibiotic Stewardship in the ICU. Chest. 2019 Jan 25;     [PubMed]
Nuttall JJC, Current antimicrobial management of community-acquired pneumonia in HIV-infected children. Expert opinion on pharmacotherapy. 2019 Jan 21;     [PubMed]
Froes F,Pereira JG,Póvoa P, Outpatient management of community-acquired pneumonia. Current opinion in pulmonary medicine. 2018 Dec 24;     [PubMed]
Mi X,Li W,Zhang L,Li J,Zeng L,Huang L,Chen L,Song H,Huang Z,Lin M, The drug use to treat community-acquired pneumonia in children: A cross-sectional study in China. Medicine. 2018 Nov;     [PubMed]
Hagel S,Moeser A,Pletz MW, [Management of community acquired pneumonia]. MMW Fortschritte der Medizin. 2018 Nov;     [PubMed]
Espinoza R,Silva JRLE,Bergmann A,de Oliveira Melo U,Calil FE,Santos RC,Salluh JIF, Factors associated with mortality in severe community-acquired pneumonia: A multicenter cohort study. Journal of critical care. 2018 Nov 22;     [PubMed]

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