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LETTERS: D Owen, Tamara Shiner, Ramachandran Sivakumar, Richard Dent, and Christopher Hilton Pneumonia: Are we putting the CURB score into practice? BMJ 2006; 332: 1213-a [Full text]

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A possible contradiction between the CURB score and the Surviving Sepsis Campaign

Thomas M Oates   (20 May 2006)

A possible contradiction between the CURB score and the Surviving Sepsis Campaign 20 May 2006
Thomas M Oates, Senior House Officer Charing Cross Hospital, London W6 8RF Send response to journal: Re: A possible contradiction between the CURB score and the Surviving Sepsis Campaign	Owen et al. highlight the possibility that intra-venous antibiotics may be over prescribed to patients with non-severe community acquired pneumonia. The surviving sepsis campaign (SSC) guidelines for management of severe sepsis and septic shock (as published in Crit Care Med 2004; 32: 858-873) recommend “intravenous antibiotic therapy should be started within the first hour of recognition of severe sepsis, after appropriate cultures.” A quantity of the literature referenced by the SSC use the fulfilment of two out of four of the systemic inflammatory response syndrome (SIRS) criteria and a systolic BP less than 90mmHg as indicative of sepsis. Given the difference between the SIRS and CURB criteria it is conceivable that a patient apparently not deemed suitable for intra-venous antibiotic treatment of pneumonia by the CURB criteria would be recommended for aggressive treatment of sepsis (including central venous and arterial access) by the SSC guidelines. This apparent contradiction illustrates the continued importance of overall clinical assessment in our increasingly guideline driven management of patients. Competing interests: None declared