August CPE Article Community-Acquired Pneumonia 2019 Guidelines: Outpatient Therapeutic Updates Authors: Taylor Hawkins, PharmD, Julie Harting, PharmD, BCIDP, and Julie Burris, PharmD
The authors declares that there are no financial relationships that could be perceived as real or apparent conflicts of interest. Universal Activity # 0143-0000-20-008-H01-P &T 1.0 Contact Hour (0.10 CEU) Expires 8/31/23
KPERF offers all CE articles to members online at www.kphanet.org
Learning Objectives: At the conclusion of this Knowledge-based article, the reader should be able to: 1.
Identify community-acquired pneumonia pathogens and limitations in the laboratory
2.
Define literature and guideline updates related to community-acquired pneumonia
3.
Compare differences between the 2007 and 2019 Infectious Diseases Society of America guidelines.
vention (CDC), and pneumonia, along with influenza, is considered the 9th leading cause of death in the United States. 5 Pneumonia is a lower respiratory tract infection that can lead After twelve years, the Infectious Disease Society of America to severe illness in all ages. Milder cases can be treated in the (IDSA and American Thoracic Society ATS) issued a CAP outpatient setting, however severe cases require hospitalizaguideline update in Fall 2019. In this time gap, the term tion. The lungs are exposed to gases, particles, and microbes health care-associated pneumonia (HCAP) was removed due in the air continuously.1 Pneumonia occurs when a large to over-utilization of broad-spectrum antimicrobial therapy in amount of an organism is present in the lower respiratory that patient population, antimicrobial resistance for common tract, or when the natural defense mechanisms are overCAP pathogens changed, and evidence regarding corticosterwhelmed.1 Pneumonia typically presents with a fever and oid treatments became available. This article will summarize respiratory symptoms consisting of cough, sputum producchanges to management of outpatient CAP. tion, chest pain, shortness of air and tachypnea. 2 Upon physDiagnosis and limitations: ical examination, the patient may present with crackles or rales.3 These signs and symptoms may also be accompanied The updated guidelines highlight that the majority of patients with laboratory and vital abnormalities such as leukocytosis will not have the etiology of CAP identified. In a multicenter, (increased white blood cells), tachycardia, low oxygen level, prospective study titled Etiology of Pneumonia in the Comand a difference in procalcitonin level.3 Pneumonia is usually munity (EPIC), Jain S, et al evaluated 2,320 hospitalized paconfirmed by visualizing infiltrates on a chest radiographic tients with CAP. Radiographic evidence and diagnostic imaging, which is a crucial part of diagnosis. methods were required to participate in the study. Sixty-two Community-acquired pneumonia (CAP) occurs in patients percent of the patients had no pathogen detected. Of those who have not resided in a hospital, long-term care facility, or with an identified pathogen, 24% were viral, 11% bacterial, nursing home 14 days prior to illness onset.1 In comparison, 1% fungal, and 3% co-infection.6 Due to the low yield of patients who are exposed to the above healthcare settings, or pathogen identification, in an outpatient setting, neither have been hospitalized or mechanically ventilated for > 48 blood cultures nor sputum gram stain or culture should be hours are categorized differently as hospital-acquired (HAP) routinely performed. Both types of cultures (blood or respiraor ventilator-associated pneumonia (VAP).4 In 2017, there tory) are only recommended in the setting of severe, inpatient were approximately 50,000 deaths due to all types of pneuCAP.2 monia according to the Centers for Disease Control and PreAs supported by the EPIC study, respiratory viruses are more Introduction:
|16| Kentucky Pharmacists Association | July/August 2020
