ICU · Rehabilitation

Acute severe community-acquired pneumonia:CAP readmission and recurrence prevention

Also known as CAP readmission prevention · CAP recurrence · Post-discharge complications · CAP prevention strategies · 30-day pneumonia readmission · Post-pneumonia discharge bundle

CAP readmission within 30 days affects roughly 1 in 10 to 1 in 4 patients across published cohorts (8-26%) and is a widely tracked hospital quality metric. Causes: incomplete recovery, complications (empyema, abscess), comorbidity exacerbation (COPD, heart failure), secondary infection, medication non-adherence, premature return to activity. Repeated-CAP readmission runs about 5% within 30 days in a population-based cohort, with CAP-unrelated readmissions roughly three times commoner (higher risk in: elderly, long-term care need, COPD, heart failure, diabetes, CKD, dementia, immunocompromised, smokers, structural lung disease, social isolation, poor functional status, previous CAP hospitalisation, aspiration risk). Prevention strategies: (1) Complete antibiotic course. (2) Smoking cessation. (3) Vaccination (pneumococcal conjugate — PCV20 or PCV21 alone, or PCV15 in series with PPSV23 per ACIP; influenza annual; COVID; RSV in elderly). (4) Treat underlying conditions (COPD optimisation, dental care for aspiration risk, heart-failure and diabetes optimisation). (5) Gradual return to activity. (6) Follow-up (GP within 7 days, CXR 6 weeks). (7) Patient education (warning signs, written action plan). (8) Pulmonary rehabilitation. (9) Address PICS (physical + cognitive impairment increases readmission risk). (10) Structured discharge bundle (medication reconciliation, follow-up appointment scheduled before discharge, vaccination offered, smoking-cessation referral, deterioration action plan).