Table 2.

Recommendations for management of CAP in persons with SCI

Hospitalization versus Outpatient Treatment: • Criteria derived from non-SCI population (Pneumonia PORT) may not accurately predict mortality in persons with SCI. • Hospitalization is strongly encouraged because of high case fatality, likelihood of resistant organisms, and possibility of inadequate secretion mobilization. • Consider the assistance available at home, the skill of the patient or caregivers with secretion mobilization, the likelihood of compliance with therapy, and the availability and accessibility of follow-up care. Optimize secretion mobilization: • Multimodal treatment • “Quad coughing” (manually assisted coughing); may precede with insufflation. • Mechanical insufflator-exsufflator (CoughAssist). Sputum Gram stain and culture. • Low diagnostic yield but should strongly be considered. • Could identify an unsuspected highly resistant organism. • If a low virulence organism is identified, the antibiotic spectrum may be narrowed to avoid promoting antibiotic resistance. Antibiotics • Evaluate risk factors for resistant organisms. Should this be considered HCAP? • Consider empiric antipseudomonal coverage. • Prompt administration of antibiotics.