CASP Resources

isolation, epidemiology, infection, prevention

This document provides guidance in management, including diagnostic evaluation, antimicrobial therapy, procedural management, and disposition, of children with community-acquired pneumonia (CAP). It is not intended to replace clinician judgment in individual cases; however, it should apply to the vast majority of patients diagnosed with CAP.

Hospital-acquired pneumonia (HAP) and Ventilator-associated pneumonia (VAP) are healthcare-acquired conditions with significant risk of morbidity and mortality. Hospitalized patients may have multiple risk factors for pneumonia, such as recumbent position, impaired cough reflex, procedural sedation, immunocompromised status, and/or artificial airways. Prompt recognition of pneumonia in hospitalized patients can prevent serious complications. However, cultures of respiratory secretions are difficult to obtain in patients without an artificial airway or have limited specificity in patients with an endotracheal tube or tracheostomy tube. This guideline document will address the diagnosis and treatment of HAP and VAP in pediatric patients at UNC Children’s. Guidelines for HAP and VAP prevention are maintained separately.

Dosing for Altered Kidney Function Doses should be individualized based on: 1) severity of infection, 2) anticipated drug penetration to site of infection; and 3) size of patient (typical dose for 70 kg patient). All weight-based dosing should be calculated using total body weight (TBW) unless otherwise noted. Calculations for ideal body weight (IBW) and adjusted body weight (adjBW) are included.

A blood culture set contains two bottles: one aerobic and one anaerobic. For the recommended two sets of blood cultures for adults, a total of four bottles are needed.

community, acquired, CAP

Being labeled with a penicillin (PCN) allergy can lead to several negative health outcomes for patients; however, improving documentation of PCN allergies in the electronic medical record can mitigate some of this risk. This guideline provides an overview of the mechanism of penicillin allergy and cross- reactivity between beta-lactams. It also provides guidance for inpatient pharmacists on how to assess, risk-stratify, document the past reaction, and provide recommendations for antibiotic use in the setting of a penicillin allergy.

CRE, OXA-48, KPC, ceftazidime-avibactam, meropenem-vaborbactam, carbapenem resistant, imipenem-relebactam, cefidericol, B-lactam

carbapenem, meropenem, ertapenem

Isolation Precautions

Antibiotic Dosing for Hemodialysis and Altered Kidney Function

Evaluating New Fever in the Pediatric Intensive Care Unit

Pediatric Community-acquired Pneumonia (CAP) and Influenza Guidelines

Assessment and Management of Hospital-aquired and Ventilator-associated Pneumonia in Children

Renal Insufficiency and Hemodialysis Antimicrobial Dosing Guideline

Best Practices for Obtaining Blood Cultures in Adults

Best Practices for Treatment of Community-acquired Bacterial Pneumonia in Hospitalized Adults

Inpatient Penicillin Allergy Assessment Guide

Guidance for the Empiric Use of Restricted Beta-lactams with Activity Against Carbapenem-resistant Enterobacterales

Carbapenem Use Guideline

Influenza Treatment Guideline