Infectious Diseases Society of America/American Thoracic Society Consensus Guidelines on the Management of Community-Acquired Pneumonia in Adults

TARGET POPULATIONDecidable
  (Y or N)
Eligibility
 
Inclusion Criterion
 
Exclusion Criterion
 
    
RECOMMENDATIONS  
    
Recommendation
Hospital admission decision.
Imperative:Severity-of-illness scores, such as the CURB-65 criteria (confusion, uremia, respiratory rate, low blood pressure, age 65 years or greater), or prognostic models, such as the Pneumonia Severity Index (PSI), can be used to identify patients with CAP who may be candidates for outpatient treatment.
 
 
IF
Inclusion Criterion:
Exclusion Criterion:
THEN
ExecutableVocab
  Use Severity-of-illness scores, such as the CURB-65 criteria to identify patients with CAP who may be candidates for out- patient treatment.
Evidence Quality:Level 1
Strength of Recommendation:Strong
Reason:
Logic:
Cost:
  
Imperative:Objective criteria or scores should always be supplemented with physician determination of subjective factors, including the ability to safely and reliably take oral medication and the availability of outpatient support resources.
 
 
IF
Inclusion Criterion:
Exclusion Criterion:
THEN
ExecutableVocab
  Supplement objective criteria or scores with physician determination of subjective factors, including ability to safely and reliably take oral medication and availability of outpatient support resources
Evidence Quality:level II evidence
Strength of Recommendation:Strong recommendation
Reason:
Logic:
Cost:
  
Conditional:For patients with CURB-65 scores ≥2, more-intensive treatment that is, hospitalization or, where appropriate and available, intensive in-home health care services is usually warranted.
 
 
IF
DecidableVocab
  patients with CURB-65 scores ≥2
THEN
ExecutableVocab
  more-intensive treatment that is, hospitalization
  where appropriate and available, intensive in-home health care services
Evidence Quality:level III evidence.
Strength of Recommendation:Moderate recommendation
Reason:
Logic:If
patients with CURB-65 scores ≥2
Then
more-intensive treatment that is, hospitalization
OR
where appropriate and available, intensive in-home health care services
  
    
Recommendation
ICU admission decision.
Conditional:Direct admission to an ICU is required for patients with septic shock requiring vasopressors or with acute respi- ratory failure requiring intubation and mechanical ven- tilation.
 
 
IF
DecidableVocab
  septic shock requiring vasopressors
  acute respiratory failure requiring intubation and mechanical ventilation.
THEN
ExecutableVocab
  Direct admission to an ICU is required
Evidence Quality:level II evidence.
Strength of Recommendation:Strong recommendation;
Reason:
Logic:
  
Conditional:Direct admission to an ICU or high-level monitoring unit is recommended for patients with 3 of the minor criteria for severe CAP listed in table 4
 
 
IF
DecidableVocab
  patients with 3 of the minor criteria for severe CAP
  
 Value: Resp rate .GE.30; PaO2/FiO2 .LE. 250; multilobar infiltrates; confusion/disorientation; uremia; leukopenia (WBC .LT.4000; thrombocytopenia <100,000; hypothermia .LT. 36; hypotension requiring aggressive fluid resuscitation 
THEN
ExecutableVocab
  Direct admission to an ICU or high-level monitoring unit
Evidence Quality:
Strength of Recommendation:
Reason:
Logic:
  
    
Recommendation
Diagnostic Testing
Imperative:In addition to a constellation of suggestive clinical features, a demonstrable infiltrate by chest radiograph or other imaging technique, with or without supporting mi- crobiological data, is required for the diagnosis of pneumonia.
 
 
IF
Inclusion Criterion:
Exclusion Criterion:
THEN
ExecutableVocab
  a constellation of suggestive clinical features is required for the diagnosis of pneumonia
  a demonstrable infiltrate by chest radiograph or other imaging technique is required for the diagnosis of pneumonia
Evidence Quality:level III evidence.
Strength of Recommendation:Moderate recommendation;
Reason:
Logic:If
Then
a constellation of suggestive clinical features is required for the diagnosis of pneumonia.
AND
a demonstrable infiltrate by chest radiograph or other imaging technique
is required for the diagnosis of pneumonia.
Cost:
  
    
Recommendation
Recommended diagnostic tests for etiology.
Conditional:Patients with CAP should be investigated for specific pathogens that would significantly alter standard (empirical) management decisions, when the presence of such pathogens is suspected on the basis of clinical and epidemiologic clues.
 
 
IF
DecidableVocab
  when the presence of pathogens that would significantly alter standard empirical management decisions is suspected on the basis of clinical and epidemiologic clues
THEN
ExecutableVocab
  Patients with CAP should be investigated for specific pathogens
Evidence Quality:level II evidence.
Strength of Recommendation:Strong recommendation;
Reason:
Logic:
  
Imperative:Routine diagnostic tests to identify an etiologic diagnosis are optional for outpatients with CAP
 
 
IF
Inclusion Criterion:
Exclusion Criterion:
THEN
ExecutableVocab
  Routine diagnostic tests to identify an etiologic diagnosis are optional for outpatients with CAP.
Evidence Quality:level III evidence.
Strength of Recommendation:Moderate recommendation;
Reason:
Logic:
Cost: