More on pneumonia: "Surviving Sepsis" campaign may contradict CURB score

doi:10.1136/bmj.332.7553.1333-b

BMJ 2006;332:1333-1334 (3 June), doi:10.1136/bmj.332.7553.1333-b

Letter

"Surviving Sepsis" campaign may contradict CURB score

The first 150 words of the full text of this article appear below.

EDITOR—Owen et al highlight the possibility that intravenousantibiotics may be overprescribed to patients with non-severecommunity acquired pneumonia.¹ The guidelines of the "SurvivingSepsis" campaign for managing severe sepsis and septic shockrecommend "intravenous antibiotic treatment should be startedwithin the first hour of recognition of severe sepsis, afterappropriate cultures."²

Some of the literature referenced by the Surviving Sepsis campaignuses the fulfilment of two out of four of the criteria for thesystemic inflammatory response syndrome and a systolic bloodpressure less than 90 mm Hg as indicative of sepsis. Given thedifference between these criteria and CURB criteria, a patientapparently not deemed suitable for intravenous antibiotic treatmentof pneumonia by the CURB criteria could be recommended for aggressivetreatment of sepsis (including central venous and arterial access)by the campaign's guidelines.

This apparent contradiction illustrates the continued importanceof overall clinical assessment in . . . [Full text of this article]

Thomas M Oates, senior house officer

Charing Cross Hospital, London W6 8RF oates_tom@hotmail.com