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Community-acquired pneumonia (CAP) is pneumonia that is contracted in the community rather than in the hospital setting. CAP is a heterogeneous infection with a variety of potential causative pathogens and is associated with significant morbidity and mortality. 1 Metlay JP, Waterer GW, Long AC, et al. Diagnosis and treatment of adults with community-acquired pneumonia. An official clinical practice guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med. 2019;200(7):e45-e67. Modi AR, Kovacs CS. Community-acquired pneumonia: Strategies for triage and treatment. Cleve Clin J Med. 2020;87(3):145-151. Metlay JP, Waterer GW, Long AC, et al. Diagnosis and treatment of adults with community-acquired pneumonia. An official clinical practice guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med. 2019;200(7):e45-e67. Metlay JP, Waterer GW, Long AC, et al. Diagnosis and treatment of adults with community-acquired pneumonia. An official clinical practice guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med. 2019;200(7):e45-e67. Metlay JP, Waterer GW, Long AC, et al. Diagnosis and treatment of adults with community-acquired pneumonia. An official clinical practice guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med. 2019;200(7):e45-e67.
For information concerning COVID-19, refer to the ARUP Consult COVID-19 topic. For information concerning hospital-acquired pneumonia, refer to the ARUP Consult Hospital-Acquired and Ventilator-Associated Pneumonia topic.
Quick Answers for Clinicians
Some of the primary bacterial pathogens associated with community-acquired pneumonia (CAP) are Streptococcus pneumoniae, Mycoplasma pneumoniae, Staphylococcus aureus, Legionella species, Chlamydia pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis. 1 Metlay JP, Waterer GW, Long AC, et al. Diagnosis and treatment of adults with community-acquired pneumonia. An official clinical practice guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med. 2019;200(7):e45-e67. Metlay JP, Waterer GW, Long AC, et al. Diagnosis and treatment of adults with community-acquired pneumonia. An official clinical practice guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med. 2019;200(7):e45-e67.
Risk factors for drug-resistant pathogens such as methicillin-resistant Staphylococcus aureus (MRSA), Pseudomonas aeruginosa, or similar multidrug-resistant Gram-negative bacteria in patients with community-acquired pneumonia (CAP) include previous identification of these organisms (particularly in respiratory tract specimens), recent hospitalization, and treatment with parenteral antibiotics. 1 Metlay JP, Waterer GW, Long AC, et al. Diagnosis and treatment of adults with community-acquired pneumonia. An official clinical practice guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med. 2019;200(7):e45-e67.
The Infectious Diseases Society of America (IDSA) and American Thoracic Society (ATS) recommend proceeding with empiric antibiotic treatment in patients with clinically suspected, radiographically confirmed community-acquired pneumonia (CAP), irrespective of procalcitonin test results. 1 Metlay JP, Waterer GW, Long AC, et al. Diagnosis and treatment of adults with community-acquired pneumonia. An official clinical practice guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med. 2019;200(7):e45-e67. Metlay JP, Waterer GW, Long AC, et al. Diagnosis and treatment of adults with community-acquired pneumonia. An official clinical practice guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med. 2019;200(7):e45-e67. Metlay JP, Waterer GW, Long AC, et al. Diagnosis and treatment of adults with community-acquired pneumonia. An official clinical practice guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med. 2019;200(7):e45-e67. Metlay JP, Waterer GW, Long AC, et al. Diagnosis and treatment of adults with community-acquired pneumonia. An official clinical practice guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med. 2019;200(7):e45-e67. Bradley JS, Byington CL, Shah SS , et al. The management of community-acquired pneumonia in infants and children older than 3 months of age: clinical practice guidelines by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America. Clin Infect Dis. 2011;53(7):e25‐e76.
Indications for Testing
Laboratory testing is indicated in patients hospitalized due to severe CAP and in patients at risk for drug-resistant pathogens. 1 Metlay JP, Waterer GW, Long AC, et al. Diagnosis and treatment of adults with community-acquired pneumonia. An official clinical practice guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med. 2019;200(7):e45-e67.
Laboratory Testing
Diagnosis
Laboratory testing has a limited role in the diagnosis of patients with CAP. Diagnosis is often based on clinical features and/or chest radiography. Current testing cannot rapidly and accurately confirm the presence of only viral pathogens at presentation; therefore, treatment does not depend on microbiologic test results but is generally empiric to cover the possibility of potential coinfection or bacterial infection. 1 Metlay JP, Waterer GW, Long AC, et al. Diagnosis and treatment of adults with community-acquired pneumonia. An official clinical practice guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med. 2019;200(7):e45-e67. Metlay JP, Waterer GW, Long AC, et al. Diagnosis and treatment of adults with community-acquired pneumonia. An official clinical practice guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med. 2019;200(7):e45-e67.
The following table summarizes circumstances in which specific tests are indicated; refer to the sections that follow for additional information.
Testing Method | Circumstances for Testing (Adults) | Circumstances for Testing (Childrena) |
---|---|---|
Blood culture | Severe CAP Current empiric treatment for MRSA or P. aeruginosa infection Positive nasal screening result for MRSA Hospitalization and parenteral antibiotics within previous 3 mosb | Failure to improve clinically or clinical decline after start of antibiotic treatment Hospitalized with moderate, severe, or complicated CAP S. aureus-caused bacteremia (repeat blood cultures to confirm bacteremia has resolved) |
Sputum Gram stain and culture | Severe CAP Intubation (note: endotracheal aspirates are preferred to sputum in patients being intubated) Current empiric treatment for (or history of) MRSA or P. aeruginosa infection Hospitalization and parenteral antibiotics within previous 3 mosb Positive nasal screening result for MRSA | Hospitalized with CAP (if able to provide a sputum sample) |
Gram stain and culture of lower respiratory tract specimens (eg, endotracheal aspirates) | Severe CAP with intubation For Legionella spp. (culture): severe CAP, unless PCR is being performed | Intubation |
Gram stain and culture of pleural fluid | If pleural fluid specimen is collected | If pleural fluid specimen is collected |
Urinary antigen tests | For Streptococcus pneumoniae: severe CAP For Legionella spp.: severe CAP or epidemiologic factors that increase risk of Legionella infection | Not recommended for diagnosis of pneumococcal pneumonia in children because results are often false positive |
PCR for influenza | Any case of CAP in an adult during seasons of increased influenza activity | Any case of CAP in a child |
PCR for other respiratory viruses | Hospitalization with suspected CAP when case is categorized as severe or patient is immunocompromised | Any case of CAP in a child |
PCR for other pathogens (eg, Mycoplasma pneumoniae, Legionella spp., Chlamydophila pneumoniae) | Consider to help guide antimicrobial therapy when clinically indicated | M. pneumoniae testing: consider to help guide antimicrobial therapy when clinically indicated |
Nasal PCR for MRSA | MRSA risk factors (severe CAP, history of MRSA or P. aeruginosa infection, previous hospitalization and treatment with parenteral antibiotics) | — |
NGS | Not currently recommended by guidelines but holds promise | Not currently recommended by guidelines but holds promise |
aThese recommendations apply to infants and children >3 months of age. bThis recommendation applies even if the antibiotics were administered outside of the hospital setting. NGS, next generation sequencing Sources: Metlay, 2019 1 Metlay JP, Waterer GW, Long AC, et al. Diagnosis and treatment of adults with community-acquired pneumonia. An official clinical practice guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med. 2019;200(7):e45-e67. Bradley JS, Byington CL, Shah SS , et al. The management of community-acquired pneumonia in infants and children older than 3 months of age: clinical practice guidelines by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America. Clin Infect Dis. 2011;53(7):e25‐e76. Hill AT, Gold PM, El Solh AA, et al. Adult outpatients with acute cough due to suspected pneumonia or influenza: CHEST guideline and expert panel report. Chest. 2019;155(1):155-167. Evans SE, Jennerich AL, Azar MM, et al. Nucleic acid-based testing for noninfluenza viral pathogens in adults with suspected community-acquired pneumonia. An official American Thoracic Society Clinical Practice Guideline. Am J Respir Crit Care Med. 2021;203(9):1070-1087. |
Blood Culture
The diagnostic contribution of blood cultures is limited for most patients with CAP. 1 Metlay JP, Waterer GW, Long AC, et al. Diagnosis and treatment of adults with community-acquired pneumonia. An official clinical practice guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med. 2019;200(7):e45-e67. Metlay JP, Waterer GW, Long AC, et al. Diagnosis and treatment of adults with community-acquired pneumonia. An official clinical practice guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med. 2019;200(7):e45-e67. Metlay JP, Waterer GW, Long AC, et al. Diagnosis and treatment of adults with community-acquired pneumonia. An official clinical practice guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med. 2019;200(7):e45-e67.
Blood cultures (along with sputum cultures) are recommended in adult patients with positive nasal screening results for MRSA. 1 Metlay JP, Waterer GW, Long AC, et al. Diagnosis and treatment of adults with community-acquired pneumonia. An official clinical practice guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med. 2019;200(7):e45-e67.
The IDSA and the Pediatric Infectious Diseases Society (PIDS) recommend blood cultures in pediatric patients (infants and children older than 3 months) in the circumstances outlined in the table above. 3 Bradley JS, Byington CL, Shah SS , et al. The management of community-acquired pneumonia in infants and children older than 3 months of age: clinical practice guidelines by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America. Clin Infect Dis. 2011;53(7):e25‐e76.
Sputum Gram Stain and Culture
Sputum evaluation has been shown to have limited utility in detecting causative organisms for CAP. 1 Metlay JP, Waterer GW, Long AC, et al. Diagnosis and treatment of adults with community-acquired pneumonia. An official clinical practice guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med. 2019;200(7):e45-e67. Metlay JP, Waterer GW, Long AC, et al. Diagnosis and treatment of adults with community-acquired pneumonia. An official clinical practice guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med. 2019;200(7):e45-e67. Metlay JP, Waterer GW, Long AC, et al. Diagnosis and treatment of adults with community-acquired pneumonia. An official clinical practice guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med. 2019;200(7):e45-e67. Metlay JP, Waterer GW, Long AC, et al. Diagnosis and treatment of adults with community-acquired pneumonia. An official clinical practice guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med. 2019;200(7):e45-e67.
Sputum cultures (along with blood cultures) are also recommended in adult patients with positive nasal screening results for MRSA. 1 Metlay JP, Waterer GW, Long AC, et al. Diagnosis and treatment of adults with community-acquired pneumonia. An official clinical practice guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med. 2019;200(7):e45-e67.
The IDSA and PIDS recommend sputum Gram stain and culture in pediatric patients (older than 3 months) hospitalized with CAP who can provide a sputum sample. 3 Bradley JS, Byington CL, Shah SS , et al. The management of community-acquired pneumonia in infants and children older than 3 months of age: clinical practice guidelines by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America. Clin Infect Dis. 2011;53(7):e25‐e76.
Gram Stain and Culture of Lower Respiratory Tract Specimens
In all patients with CAP who must be intubated, Gram stain and culture of lower respiratory tract specimens, such as endotracheal aspirates, should be performed soon after intubation. 1 Metlay JP, Waterer GW, Long AC, et al. Diagnosis and treatment of adults with community-acquired pneumonia. An official clinical practice guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med. 2019;200(7):e45-e67. Metlay JP, Waterer GW, Long AC, et al. Diagnosis and treatment of adults with community-acquired pneumonia. An official clinical practice guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med. 2019;200(7):e45-e67.
Culture of lower respiratory tract specimens for Legionella is recommended in patients with severe CAP, unless PCR testing for Legionella is performed. 1 Metlay JP, Waterer GW, Long AC, et al. Diagnosis and treatment of adults with community-acquired pneumonia. An official clinical practice guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med. 2019;200(7):e45-e67.
Gram Stain and Culture of Pleural Fluid
For pediatric patients older than 3 months with CAP, the IDSA and PIDs recommend Gram stain and culture of any pleural fluid specimen obtained. 3 Bradley JS, Byington CL, Shah SS , et al. The management of community-acquired pneumonia in infants and children older than 3 months of age: clinical practice guidelines by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America. Clin Infect Dis. 2011;53(7):e25‐e76.
Urinary Antigen Tests
Urinary antigen testing can be used as an alternative method to identify Legionella species and S. pneumoniae. However, urinary antigen testing for S. pneumoniae is not recommended for routine use in patients with CAP, except in cases of severe CAP. 1 Metlay JP, Waterer GW, Long AC, et al. Diagnosis and treatment of adults with community-acquired pneumonia. An official clinical practice guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med. 2019;200(7):e45-e67.
Use of this testing for Legionella spp. is recommended only in those with severe CAP or with epidemiologic factors that increase the risk of Legionella infection (eg, recent travel or potential exposure during a Legionella outbreak). 1 Metlay JP, Waterer GW, Long AC, et al. Diagnosis and treatment of adults with community-acquired pneumonia. An official clinical practice guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med. 2019;200(7):e45-e67. Metlay JP, Waterer GW, Long AC, et al. Diagnosis and treatment of adults with community-acquired pneumonia. An official clinical practice guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med. 2019;200(7):e45-e67.
Urinary antigen testing is not recommended for the diagnosis of pneumococcal pneumonia in pediatric patients (older than 3 months) because results are often false positive. 3 Bradley JS, Byington CL, Shah SS , et al. The management of community-acquired pneumonia in infants and children older than 3 months of age: clinical practice guidelines by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America. Clin Infect Dis. 2011;53(7):e25‐e76.
Inflammatory Marker Tests
Bacterial etiologies have been associated with higher serum procalcitonin concentrations, but a cutoff level to distinguish viral from bacterial illness has not been established. 1 Metlay JP, Waterer GW, Long AC, et al. Diagnosis and treatment of adults with community-acquired pneumonia. An official clinical practice guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med. 2019;200(7):e45-e67. Metlay JP, Waterer GW, Long AC, et al. Diagnosis and treatment of adults with community-acquired pneumonia. An official clinical practice guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med. 2019;200(7):e45-e67. Hill AT, Gold PM, El Solh AA, et al. Adult outpatients with acute cough due to suspected pneumonia or influenza: CHEST guideline and expert panel report. Chest. 2019;155(1):155-167.
C-reactive protein (CRP) levels may be useful to either support or rule out the diagnosis of CAP. CRP levels >30 mg/L, in conjunction with clinical signs and symptoms associated with pneumonia, support a CAP diagnosis. 4 Hill AT, Gold PM, El Solh AA, et al. Adult outpatients with acute cough due to suspected pneumonia or influenza: CHEST guideline and expert panel report. Chest. 2019;155(1):155-167. Hill AT, Gold PM, El Solh AA, et al. Adult outpatients with acute cough due to suspected pneumonia or influenza: CHEST guideline and expert panel report. Chest. 2019;155(1):155-167.
The IDSA and PIDs do not recommend the use of inflammatory marker testing for pediatric outpatients with CAP, but suggest that in cases of severe illness, these tests may be useful to aid in clinical management and to gauge treatment response. 3 Bradley JS, Byington CL, Shah SS , et al. The management of community-acquired pneumonia in infants and children older than 3 months of age: clinical practice guidelines by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America. Clin Infect Dis. 2011;53(7):e25‐e76.
Polymerase Chain Reaction Tests
A rapid influenza PCR is recommended in adult patients with CAP during seasons of increased influenza activity but is not essential when few influenza cases are being reported. 1 Metlay JP, Waterer GW, Long AC, et al. Diagnosis and treatment of adults with community-acquired pneumonia. An official clinical practice guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med. 2019;200(7):e45-e67. Bradley JS, Byington CL, Shah SS , et al. The management of community-acquired pneumonia in infants and children older than 3 months of age: clinical practice guidelines by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America. Clin Infect Dis. 2011;53(7):e25‐e76.
Although PCR testing for other respiratory viruses is not recommended for adults in an outpatient setting, the ATS recommends this testing in hospitalized adults with suspected CAP who are immunocompromised or whose illness is categorized as severe. For a list of criteria for severe CAP, refer to the ATS clinical guidelines. 5 Evans SE, Jennerich AL, Azar MM, et al. Nucleic acid-based testing for noninfluenza viral pathogens in adults with suspected community-acquired pneumonia. An official American Thoracic Society Clinical Practice Guideline. Am J Respir Crit Care Med. 2021;203(9):1070-1087.
PCR tests for pathogens such as M. pneumoniae, Legionella spp., and C. pneumoniae can be considered to help guide empiric therapy when clinically indicated (eg, in patients with severe CAP, either culture of lower respiratory tract specimens or PCR for Legionella is recommended). 1 Metlay JP, Waterer GW, Long AC, et al. Diagnosis and treatment of adults with community-acquired pneumonia. An official clinical practice guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med. 2019;200(7):e45-e67.
Nasal Swab for MRSA
Nasal PCR offers high specificity and negative predictive value (NPV) for MRSA pneumonia. 6 Parente DM, Cunha CB, Mylonakis E, et al. The clinical utility of methicillin resistant Staphylococcus aureus (MRSA) nasal screening to rule out MRSA pneumonia: a diagnostic meta-analysis with antimicrobial stewardship implications. Clin Infect Dis. 2018;67(1):1‐7. Metlay JP, Waterer GW, Long AC, et al. Diagnosis and treatment of adults with community-acquired pneumonia. An official clinical practice guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med. 2019;200(7):e45-e67. Parente DM, Cunha CB, Mylonakis E, et al. The clinical utility of methicillin resistant Staphylococcus aureus (MRSA) nasal screening to rule out MRSA pneumonia: a diagnostic meta-analysis with antimicrobial stewardship implications. Clin Infect Dis. 2018;67(1):1‐7.
The positive predictive value (PPV) is low for nasal swab testing. 6 Parente DM, Cunha CB, Mylonakis E, et al. The clinical utility of methicillin resistant Staphylococcus aureus (MRSA) nasal screening to rule out MRSA pneumonia: a diagnostic meta-analysis with antimicrobial stewardship implications. Clin Infect Dis. 2018;67(1):1‐7. Metlay JP, Waterer GW, Long AC, et al. Diagnosis and treatment of adults with community-acquired pneumonia. An official clinical practice guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med. 2019;200(7):e45-e67. Metlay JP, Waterer GW, Long AC, et al. Diagnosis and treatment of adults with community-acquired pneumonia. An official clinical practice guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med. 2019;200(7):e45-e67. Parente DM, Cunha CB, Mylonakis E, et al. The clinical utility of methicillin resistant Staphylococcus aureus (MRSA) nasal screening to rule out MRSA pneumonia: a diagnostic meta-analysis with antimicrobial stewardship implications. Clin Infect Dis. 2018;67(1):1‐7.
Nasal screening for MRSA is not recommended in patients with recent nasal decolonization or MRSA infection that occurred in the 30 days preceding hospital admission. 6 Parente DM, Cunha CB, Mylonakis E, et al. The clinical utility of methicillin resistant Staphylococcus aureus (MRSA) nasal screening to rule out MRSA pneumonia: a diagnostic meta-analysis with antimicrobial stewardship implications. Clin Infect Dis. 2018;67(1):1‐7.
Next Generation Sequencing
NGS is an emerging technology that holds promise in identifying pathogens without requiring advance knowledge of those likely to be involved. 7 Deurenberg RH, Bathoorn E, Chlebowicz MA, et al. Application of next generation sequencing in clinical microbiology and infection prevention. J Biotechnol. 2017;243:16-24.
Other Tests
Although CAP is often diagnosed without imaging, the detection of infiltrate on a chest radiograph can be beneficial in confirming diagnosis. 1 Metlay JP, Waterer GW, Long AC, et al. Diagnosis and treatment of adults with community-acquired pneumonia. An official clinical practice guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med. 2019;200(7):e45-e67. Hill AT, Gold PM, El Solh AA, et al. Adult outpatients with acute cough due to suspected pneumonia or influenza: CHEST guideline and expert panel report. Chest. 2019;155(1):155-167.
Risk Stratification
Risk stratification calculators are often used to evaluate illness severity in patients with CAP and make determinations about inpatient versus outpatient treatment. 2 Modi AR, Kovacs CS. Community-acquired pneumonia: Strategies for triage and treatment. Cleve Clin J Med. 2020;87(3):145-151. Metlay JP, Waterer GW, Long AC, et al. Diagnosis and treatment of adults with community-acquired pneumonia. An official clinical practice guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med. 2019;200(7):e45-e67. Modi AR, Kovacs CS. Community-acquired pneumonia: Strategies for triage and treatment. Cleve Clin J Med. 2020;87(3):145-151.
Patient assessment based on the IDSA/ATS major and minor criteria defined in 2007, rather than the PSI or other calculators, is recommended to determine intensive care unit (ICU) admission. 1 Metlay JP, Waterer GW, Long AC, et al. Diagnosis and treatment of adults with community-acquired pneumonia. An official clinical practice guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med. 2019;200(7):e45-e67. Metlay JP, Waterer GW, Long AC, et al. Diagnosis and treatment of adults with community-acquired pneumonia. An official clinical practice guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med. 2019;200(7):e45-e67. Metlay JP, Waterer GW, Long AC, et al. Diagnosis and treatment of adults with community-acquired pneumonia. An official clinical practice guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med. 2019;200(7):e45-e67.
Monitoring
Procalcitonin and CRP can be used in more severe cases of CAP in pediatric patients, in conjunction with clinical findings, to evaluate response to treatment. 3 Bradley JS, Byington CL, Shah SS , et al. The management of community-acquired pneumonia in infants and children older than 3 months of age: clinical practice guidelines by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America. Clin Infect Dis. 2011;53(7):e25‐e76. Metlay JP, Waterer GW, Long AC, et al. Diagnosis and treatment of adults with community-acquired pneumonia. An official clinical practice guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med. 2019;200(7):e45-e67.
Testing to determine antibiotic levels in serum can also be used to help optimize antibiotic concentrations and dosing (refer to the ARUP Consult Therapeutic Drug Monitoring topic for testing details).
ARUP Laboratory Tests
Cell Culture/Immunofluorescence
Cell Culture
Direct Fluorescent Antibody (DFA) Stain/Cell Culture
Cell Culture/Immunofluorescence
Qualitative Culture
Culture/Identification
Qualitative Immunochromatography
Qualitative Enzyme-Linked Immunosorbent Assay
Quantitative Chemiluminescent Immunoassay (CLIA)
Quantitative Immunoturbidimetry
Semi-Quantitative Polymerase Chain Reaction (PCR)/Qualitative Polymerase Chain Reaction (PCR)
For additional information about this multiplex PCR test, refer to the Pneumonia Panel by PCR Test Fact Sheet.
Qualitative Reverse Transcription Polymerase Chain Reaction
Qualitative Polymerase Chain Reaction
Qualitative Polymerase Chain Reaction (PCR)
Qualitative Polymerase Chain Reaction
Qualitative Polymerase Chain Reaction
Qualitative Polymerase Chain Reaction
References
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31573350
Metlay JP, Waterer GW, Long AC, et al. Diagnosis and treatment of adults with community-acquired pneumonia. An official clinical practice guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med. 2019;200(7):e45-e67.
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32127438
Modi AR, Kovacs CS. Community-acquired pneumonia: Strategies for triage and treatment. Cleve Clin J Med. 2020;87(3):145-151.
-
21880587
Bradley JS, Byington CL, Shah SS , et al. The management of community-acquired pneumonia in infants and children older than 3 months of age: clinical practice guidelines by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America. Clin Infect Dis. 2011;53(7):e25‐e76.
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30296418
Hill AT, Gold PM, El Solh AA, et al. Adult outpatients with acute cough due to suspected pneumonia or influenza: CHEST guideline and expert panel report. Chest. 2019;155(1):155-167.
-
33929301
Evans SE, Jennerich AL, Azar MM, et al. Nucleic acid-based testing for noninfluenza viral pathogens in adults with suspected community-acquired pneumonia. An official American Thoracic Society Clinical Practice Guideline. Am J Respir Crit Care Med. 2021;203(9):1070-1087.
-
29340593
Parente DM, Cunha CB, Mylonakis E, et al. The clinical utility of methicillin resistant Staphylococcus aureus (MRSA) nasal screening to rule out MRSA pneumonia: a diagnostic meta-analysis with antimicrobial stewardship implications. Clin Infect Dis. 2018;67(1):1‐7.
-
28042011
Deurenberg RH, Bathoorn E, Chlebowicz MA, et al. Application of next generation sequencing in clinical microbiology and infection prevention. J Biotechnol. 2017;243:16-24.
(Note: Primary microbiology tests should be performed as close to the patient as possible.)