Journal Article

Diagnosis and management of community and hospital acquired pneumonia in adults: summary of NICE guidance

Woodhead, Mark, Eccles, Sinan, Higgins, Bernard, Pincus, Celia

2014

Overview

Community acquired pneumonia is a common condition that causes considerable morbidity and has a mortality rate of approximately 20% for patients admitted to hospital in the United Kingdom. 1 It is diagnosed in 5-12% of adults who present to general practitioners with symptoms of lower respiratory tract infection, 2 3 and 22-42% are subsequently admitted to hospital. 3 4 Adherence to previous guidelines has been poor, and this variation in practice can lead to suboptimal outcomes such as increased mortality and longer stay in hospital. 5 6 7 Hospital acquired pneumonia (excluding ventilator associated pneumonia) has a point prevalence of approximately 1% of hospital inpatients, is estimated to lengthen hospital admission by an average of eight days, and has a high mortality rate. 8 9 This article summarises the most recent recommendations for the management of both types of pneumonia from the National Institute for Health and Care Excellence (NICE). Confusion (abbreviated mental test score 8 or less or new disorientation in person, place, or time)* Raised blood urea nitrogen (over 7 mmol/L) Raised respiratory rate (30 breaths per minute or more) Low blood pressure (diastolic 60 mm Hg or less, or systolic less than 90 mm Hg) Age 65 years or more Patients are stratified for risk of death as follows: 0 or 1=low risk (less than 3% mortality risk) 2=intermediate risk (3 to 15% mortality risk) 3 to 5=high risk (more than 15% mortality risk) *For guidance on delirium, please refer to National Institute for Health and Care Excellence.

• Publisher: British Medical Journal Publishing Group,BMJ Publishing Group LTD
• Subject: Adrenal Cortex Hormones - therapeutic use / Adult / Anti-Bacterial Agents - therapeutic use / Antibiotics / Blood pressure / C-Reactive Protein - analysis / Community-Acquired Infections - diagnosis / Community-Acquired Infections - therapy / Cross Infection - diagnosis / Cross Infection - therapy / Delirium / GUIDELINES / Hospitalization / Hospitals / Humans / Infections / Intensive care / Mortality / Pneumonia / Pneumonia - diagnosis / Pneumonia - therapy / Practice Guidelines as Topic / Proteins / Risk assessment / United Kingdom