A multidisciplinary team worked over the last few months to develop a new Pneumonia care pathway and update the corresponding inpatient order sets. The pathway and order sets now reflect current evidenced-based recommendations from the ATS-IDSA guidelines and better align with our Valley antibiotic stewardship guides.

A summary of care recommendations includes:

• Use the DSCRB-65 and Pneumonia Severity index (PSI) Severe CAP criteria together with clinical judgement to guide the need for higher levels of treatment intensity.
• The preferred antibiotic treatment for community acquired bacterial pneumonia (CAP) remains ceftriaxone and azithromycin. Rocephin and Zithromax can be used for moderate presentation. Standard treatment for severe CAP includes Cefipime. Zithromycin, and Vancomycin.
• Healthcare associated pneumonia (HCAP) previously defined based on healthcare or antibiotic exposures is no longer a designated category by ATS-IDSA guidelines. Instead treatment should be selected based on clinical presentation and severity of illness.
• All patients with severe pneumonia requiring admission to CCU should be covered empirically for MRSA and Pseudomonas
• Anti-Pseudomonal coverage should be considered for patients with structural lung disease regardless of CCU admission
• Pre-treatment blood and sputum cultures are not routinely recommended for patients with CAP. Obtain cultures only for patients classified as severe CAP, concern for sepsis, or where there is a high suspicion of MRSA/Pseudomonas infection.
• The Bronchial Hygiene Protocol (BHP) should be ordered for patients with poor secretion management and increased oxygen demand. Incentive spirometry (IS) is not associated with improved outcomes or decreased length of stay. IS should only be utilized with non-mobile patients.
• Don’t treat aspiration unless a large aspiration event or abscess is suspected; treating aspiration pneumonitis on CXR or possible aspiration is not recommended. If treating aspiration use Flagyl as first choice.
• Refer patients to Pulmonary for outpatient follow-up who have severe pneumonia, structural lung diseases with recurrent exacerbations, or more complicated pneumonia cases including multi-lobar presentation, MRSA/Pseudomonas infection, complicated parapneumonic effusions, and empyema.

Please see the following documents for additional guidance:

Pneumonia Care Pathway

Pneumonia Provider Education

Please contact CarePathways@valleymed.org with any question, concerns, or general feedback about the new pathway.