BACTERIAL PNEUMONIA
OVERVIEW
Bacterial pneumonia is a bacterial infection of the lungs that can cause mild to severe illness in
people of all ages. The most common cause of bacterial pneumonia in adults is Streptococcus
pneumonia. Pneumonia may also be caused by non-bacterial microorganisms such as the
influenza virus, adenovirus, parainfluenza and respiratory syncytial virus (RSV). RSV is the most
common cause of pneumonia in children below the age of 1.
Common symptoms associated with pneumonia are productive cough, fever and fatigue. Other
associated symptoms such as nausea, vomiting, increased respirations, chills, and chest pain
may also occur.
There are two types of pneumonia. Community-acquired pneumonia (CAP) occurs in people
who have not recently been in a hospital or other healthcare related facility. Healthcareassociated pneumonia (HCAP) occurs in people with frequent or recurring admissions to
healthcare-related facilities such as hospitals, long-term care facilities, and dialysis centers.
Hospitalization for treatment may be required although, in otherwise healthy individuals,
bacterial pneumonia can commonly be treated with antibiotics outside of the hospital setting.
Groups that are more likely to get pneumonia include:
 Adults 65 years of age or older;
 Children younger than 5 years of age;
 People who have underlying medical conditions such as diabetes, HIV/AIDS or heart
disease; and
 People who smoke cigarettes or have asthma.
The most widely used guidelines for the management of pneumonia have been published by
the Infectious Diseases Society of America (IDSA) and the American Thoracic Society (ATS)
(IDSA/ATS guidelines.)
STATISTICS
According to the CDC, influenza and pneumonia were the 9th leading cause of death in 2010 in
the US. It is estimated that 1.1 million people were hospitalized with pneumonia and 50,000
people died from the disease in the US in 2010. Globally, pneumonia is responsible for the
death of over 1 million children under the age of 5 annually.
In Texas, bacterial pneumonia resulted in 44,570 hospitalizations in 2012. The average stay was
5 days and the average charges were $38,606.
PREVENTION
Prevention activities focus primarily on vaccinations and smoking cessation.
Vaccinations
One method of preventing bacterial pneumonia is encouraging compliance with the
immunization guidelines .
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1) Pneumococcal Vaccines
a. Pneumococcal conjugate 13-valent vaccination (PCV13) is recommended for:
 All infants, children and adults aged 19 years or older with
immunocompromising conditions, functional or anatomic asplenia, CSF leaks or
cochlear implants, and those who have not previously received PCV13 or
PPSV23.
b. Pneumococcal polysaccharide (PPSV23) vaccination is recommended for:
 All persons aged 65 and older;
 Persons below the age of 65 with chronic medical conditions such as:
o Chronic heart, liver and lung disease, diabetes mellitus, chronic kidney, or
liver disease, alcoholism, cochlear implants, cerebrospinal fluid leaks,
immunocompromising conditions, asplenia, or splenic dysfunction;
 All adults who smoke cigarettes; and
 All residents of nursing homes or long term facilities.
2) Annual Influenza vaccination is recommended for:
 All persons aged 6 months and older.
Bacterial pneumonia is a complication of the flu.
3) Tdap vaccination (Tetanus, diphtheria, and acellular pertussis) is recommended for:
 All adults who have not previously received Tdap or for whom vaccine status is
unknown.
Pertussis, more commonly known as whooping cough, is a rare cause of pneumonia itself but
pneumonia is a major complication of pertussis.
Smoking Cessation
Smoking cessation is strongly encouraged because it is associated with an increased risk of
bacterial pneumonia.4
TREATMENT
As with most preventable hospitalizations, access to outpatient care is paramount. Many cases
of bacterial pneumonia can be treated with outpatient antibiotics. The IDSA/ATS guidelines
outline the Pneumonia Severity Index (PSI) and CURB-65 criteria to determine which patients
can be safely treated without hospitalization.6 The simplest set of criteria is CURB-65, which is
an acronym for 5 easily measured clinical factors6:
Confusion - disorientation to person, place, or time
Uremia - elevated Blood Urea Nitrogen (BUN) on chemistry panel
Respiratory rate - >30 breaths/min
Blood pressure (BP) - systolic BP<90 or diastolic BP<60
65 -age >65 years
Patients with 0-1 factors can generally be treated as outpatients, those with 2 factors should be
admitted to the hospital, and those with 3 or more factors may need treatment in an intensive
care unit. A simplified version of the CURB-65 criteria, without the blood testing required for
BUN determination, may be appropriate for decision making in a primary care provider’s office.
Most patients who present with pneumonia receive empirical antibiotic treatment based on the
prediction of the most likely pathogen. Supportive therapy such as oxygen, bronchodilators,
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fever reducers, proper nutrition and hydration should also be provided to patients if needed.
Please refer to the IDSA/ATS guidelines for antibiotic treatment recommendations.
REDUCING REHOSPITALIZATIONS
Avoiding pneumonia hospitalization and rehospitalizations can result in substantial savings.
Listed below are some ways in which pneumonia hospitalizations/-rehospitalizations can be
prevented:
 Eradicating the infecting organism through the selection of the appropriate
antibiotic;
 Addressing comorbidities such as COPD/asthma, diabetes, renal and liver disease.
Comorbidities are associated with increased pneumonia readmissions;
 Ensuring that patients’ vaccinations are up to date;
 Providing patient education during discharge. States that provided discharge
information had a lower pneumonia readmission rates among Medicare patients;
 Discharging patients when they are clinically stable. Refer to the IDSA/ATS guidelines
for the criteria of clinical stability; and
 Setting up appropriate follow-up care.
RESOURCES
 Smoking cessation - 1800-QUIT-NOW
 Call 2-1-1 or visit www.211texas.org to find information about resources in your
local community
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References:
Adult immunization schedule, United States 2013. Centers for Disease Control and
Prevention website. http://www.cdc.gov/vaccines/schedules/hcp/adult.html. Published
February 3, 2014. Accessed February 19, 2014.
Ewig, S, Welte, T, Chastre, J, Torres, A. Rethinking the concepts of community acquired
and health-care-associated pneumonia. Lancet Infect Dis 2010; 10:279-287.
Jasti H, Mortensen EM, Obrosky DS, Kapoor WN, Fine MJ. Causes and Risk Factors for
Rehospitalization of Patients Hospitalized with Community-Acquired Pneumonia. Clin
Infect Dis 2008; 46(4):550-6.
Key Facts about Influenza (Flu) & Flu Vaccine. Centers for Disease Control and
Prevention website. http://www.cdc.gov/flu/keyfacts.htm. Published September 26,
2013. Accessed February 20, 2014.
Mandell LA, Wunderink RG, Anzueto A, et al. Infectious Diseases Society of
America/American Thoracic Society Consensus Guidelines on the Management of
Community-Acquired Pneumonia in Adults. Clin Infect Dis 2007; 44:S27-72.
Pneumonia can be prevented-vaccines can help. Centers for Disease Control and
Prevention website. http://www.cdc.gov/features/pneumonia/. Updated February 18,
2014. Accessed February 19, 2014.
Pneumonia. World Health Organization web site.
http://www.who.int/mediacentre/factsheets/fs331/en/. Updated November 2013.
Accessed February 20, 2014.
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8. Schmeida, M, Savrin, R A. Pneumonia Rehospitalization of the Medicare Fee-for-Service
Patient: A State-Level Analysis: Exploring 30-Day Readmission Factors. Professional Case
Management 2012; 17(3):126–31.
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