What are the admission criteria for community-acquired pneumonia (CAP)?

From the Guidelines

Admission criteria for community-acquired pneumonia (CAP) should be based on severity assessment tools, such as the CURB-65 score and the Pneumonia Severity Index (PSI), as well as clinical judgment, with patients having a CURB-65 score ≥3 or PSI class IV-V generally requiring hospitalization. The most recent and highest quality study, published in 2019 1, provides guidance on the diagnosis and treatment of adults with community-acquired pneumonia. According to this study, specific criteria warranting admission include:

• Respiratory distress (respiratory rate >30 breaths/minute)
• Hypoxemia (oxygen saturation <90% or PaO2 <60 mmHg on room air)
• Hypotension (systolic blood pressure <90 mmHg)
• Altered mental status
• Significant comorbidities (such as COPD, diabetes, heart failure, or immunosuppression)
• Inability to maintain oral intake
• Lack of adequate home support
• Failed outpatient therapy Laboratory findings suggesting severe disease include:
• Leukopenia (<4,000 cells/mm³)
• Severe leukocytosis (>20,000 cells/mm³)
• Acute kidney injury
• Multilobar involvement on imaging Patients with septic shock or requiring mechanical ventilation need ICU admission. Clinical judgment remains essential, as individual patient factors may warrant admission even when formal severity scores suggest outpatient management is possible. The 2019 study 1 also provides guidance on initial treatment strategies for inpatients with community-acquired pneumonia, including the use of parenteral antibiotics and coverage for MRSA and P. aeruginosa in certain cases. The study emphasizes the importance of clinical judgment and individualized care in the management of CAP.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Admission Criteria for Community Acquired Pneumonia

The decision to admit a patient with community-acquired pneumonia (CAP) depends on various factors, including the severity of the disease, the presence of comorbidities, and the patient's overall health status. The following are some of the key considerations:

• The Pneumonia Severity Index (PSI) and CURB-65 scores are commonly used to assess the severity of CAP and guide admission decisions 2, 3.
• Patients with PSI risk classes I-III (low risk) may be eligible for outpatient treatment, while those with higher risk classes may require hospitalization 4.
• The CURB-65 score can also be used to identify patients at high risk of mortality, with a score of 3 or higher indicating a higher risk of death 3, 5.
• Other factors that may influence admission decisions include the presence of comorbidities, such as heart disease or diabetes, and the patient's age and functional status 2, 6.
• The use of biomarkers, such as procalcitonin, may also help guide admission decisions and antibiotic therapy 2.

Severity Assessment Tools

Several severity assessment tools are available to help guide admission decisions, including:

• The Pneumonia Severity Index (PSI), which categorizes patients into five risk classes based on their age, comorbidities, and physical examination findings 2, 4.
• The CURB-65 score, which assigns points for confusion, urea, respiratory rate, blood pressure, and age 3, 5.
• The Acute Physiology and Chronic Health Evaluation II (APACHE II) score, which assesses the severity of illness based on physiological parameters 5.

Hospital Admission Patterns

Studies have shown that hospital admission patterns for CAP vary widely, with admission rates ranging from 22-61% 6.

• A study of patients with CAP who received ceftriaxone and a macrolide found that approximately 70% of patients were in PSI risk classes I-III, suggesting that many patients may be eligible for outpatient treatment 4.
• Another study found that the use of PSI and CURB-65 scores can help identify patients at high risk of mortality and guide admission decisions 5.