Sections View Full Chapter Figures Tables Videos Full Chapter Figures Tables Videos Supplementary Content ++ Pneumonia: acute infection of pulmonary parenchymaRoute of entry: aspiration of oropharyngeal contents, inhalation of aerosolized particles, hematogenous spread from extrapulmonary siteAlteration in host defenses: ↓ alveolar macrophage function, ↓ mucociliary clearance ++Table Graphic Jump LocationTable 26-1 Pneumonia Definitions (Am J Respir Crit Care Med 2005;171:338)View Table|Favorite Table|Download (.pdf)Table 26-1 Pneumonia Definitions (Am J Respir Crit Care Med 2005;171:338)Community-acquired pneumonia (CAP)Community-dwelling outpatient, or inpatient if diagnosis w/in 48h of admissionHealthcare-associated pneumonia (HCAP)Community-dwelling patient admitted w/recent healthcare contact, recent hospitalization (≥2d in previous 90d), residence in a nursing home or LTCF, home infusion therapy or wound care, or chronic dialysisHospital-acquired pneumonia (HAP)≥48h after hospital admissionVentilator-associated pneumonia (VAP)48–72h after endotracheal intubation +++ Diagnosis & Evaluation ++ (JAMA 1997;278:1440) ++ Required: acute infiltrate on chest radiographySigns & symptoms of acute infection (↑ temp, ↑ WBCs), respiratory complaints (productive cough, dyspnea, pleuritic chest pain), systemic complaints (fatigue, anorexia, myalgias); auscultatory findings (dullness to percussion, Δ in breath sounds, wheezes, crackles, egophony) +++ Microbiological Diagnosis ++ Blood cultures (preantibiotics) = low positive yield (5–14%)—obtain if severe CAP/ICU admission & selected hospitalized patients (cavitary infiltrates, leukopenia, active EtOH abuse, severe liver disease, asplenia, pleural effusion)Gram stain & sputum culture: variable yield, influenced by quality; in intubated patients: collect endotracheal aspirateUrinary antigen tests → S. pneumoniae: sensitivity 50–80%, specificity >90% (Arch Intern Med 2011;171:166); L. pneumophila serogroup 1: sensitivity 70–90%, specificity 99% ++Table Graphic Jump LocationTable 26-2 Prognostic Scoring Systems in CAPView Table|Favorite Table|Download (.pdf)Table 26-2 Prognostic Scoring Systems in CAPPSI (N Engl J Med 1997;336:243)PSI InterpretationAgeObjective FindingsScoreClassDeath, %MenWomenNH residentComorbiditiesNeoplasticLiverCHFCerebrovascularRenal+ # of y+ # of y–10+10+30+20+10+10+10AMSRR ≥30SBP <90T <95 or ≥104°FHR ≥125Arterial pH <7.35BUN ≥30Na <130Glucose ≥250Hct <30PaO2 <60Pleural effusion+20+20+20+15+10+30+20+20+10+10+10+10n/a*≤7071–9091–130>130IIIIIIIVV<0.5<11–3∼9∼30ClassI–IIII–IIIIV–VPoint of CareAssess for outptAssess for inptAssess for ICUCURB-65 (Thorax 2003;58:377)CURB-65 InterpretationConfusion+1Score0–12≥3Death, %1.5∼922Point of CareAssess for outptAssess for inptAssess for ICUUremia (BUN ≥20)>+1Respiratory rate ≥30+1Blood pressure (<90/60)+1Age ≥65+1*Risk class I: age <50y without any PSI comorbidities, AMS, or qualifying HR, RR, SBP, or temp. ++Table Graphic Jump LocationTable 26-3 Criteria for Severe CAPView Table|Favorite Table|Download (.pdf)Table 26-3 Criteria for Severe CAPMajor CriteriaMinor CriteriaInvasive mechanical ventilationSeptic shock with need for ... GET ACCESS TO THIS RESOURCE Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Username? Forgot Password? Sign in via OpenAthens Sign in via Shibboleth Get Free Access Through Your Institution Contact your institution's library to ask if they subscribe to McGraw-Hill Medical Products. Access My Subscription GET ACCESS TO THIS RESOURCE Subscription Options Pay Per View Timed Access to all of AccessPharmacy 24 Hour $34.95 (USD) Buy Now 48 Hour $54.95 (USD) Buy Now Best Value AccessPharmacy Full Site: One-Year Individual Subscription $595 USD Buy Now View All Subscription Options