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Wan YD, Marrie TJ. Comprehensive molecular testing for respiratory pathogens in community-acquired pneumonia. Chalmers JD. Michael T. Risk and severity of CAP, including infection with less common pathogens (e.g., Legionella species), increase with older age, cardiopulmonary disease, poor baseline functional status, low socioeconomic status, and recent weight loss or underweight status.4,9 Although a thorough history is an essential component in the diagnosis of CAP, no individual symptom can adequately predict its presence. 34. 2013;57(4):e22–e121. 3. Lung ultrasonography has the potential to more accurately and efficiently diagnose pneumonia, as well as pleural effusions, pneumothorax, pulmonary embolism, and pulmonary contusions.17 Two recent meta-analyses using chest computed tomography as the comparative standard show that lung ultrasonography has a pooled sensitivity of 0.94 to 0.95 (95% confidence interval [CI], 0.92 to 0.97) and a specificity of 0.90 to 0.96 (95% CI, 0.86 to 0.97), with LR+ = 16.8 (95% CI, 7.7 to 37.0) and LR− = 0.07 (95% CI, 0.05 to 0.10), compared with chest radiography (pooled sensitivity = 0.77 [95% CI, 0.73 to 0.80]; specificity = 0.91 [95% CI, 0.87 to 0.94]) for diagnosis of pneumonia.17,18 Because lung ultrasonography can be performed at the bedside in an average of 13 minutes and lacks ionizing radiation, it is a promising diagnostic option in primary care and emergency department settings.18 Physicians should consider use of chest computed tomography when concern for alternative or concurrent diagnoses remains high (e.g., interstitial lung disease, cavitary lesions, sarcoidosis, malignancy). Boersma WG. Myrsini M, Guan W, Christ-Crain M, Sun TW, Bartlett JG. 1984;37(3):215–225. Lee JS, Mandell LA, Blood and sputum cultures should be obtained in the presence of specific risk factors or with severe CAP (Table 46,20) when culture results can alter antibiotic selection.6 A study of 833 patients with pneumococcal CAP, 47% of whom were bacteremic, showed a marginal but statistically significant increase in the length of stay, time to clinical stability, and in-hospital mortality for bacteremic patients.21 However, an earlier study showed no change in outcomes and demonstrated the potential for false-positive blood cultures to cause prolonged hospitalization and unnecessary vancomycin use.22, Endotracheal aspirate or bronchoalveolar lavage, Pleural effusion (> 5 cm) on lateral chest radiography, Thoracentesis and pleural fluid cultures (including Gram stain with or without AFB), Bronchoscopic or sputum specimen nucleic acid amplification test, Severe obstructive or structural lung disease, Travel within past two weeks or foreign-born. Choose a single article, issue, or full-access subscription. Reyburn SW. CAP is a major healthcare and economic problem because of its high morbidity and mortality rate, and because of its direct and indirect costs of management 1, 3. The incidence rate and economic burden of community-acquired pneumonia in a working-age population. Most outpatients with community-acquired pneumonia do not require microbiologic testing of sputum or blood and can be treated empirically with a macrolide, doxycycline, or a respiratory fluoroquinolone. Levofloxacin efficacy in the treatment of community-acquired legionellosis. Metlay JP, Waterer GW, Long AC, et al. Wise MP, Verheij TJ, In contrast, hospital-acquired pneumonia (HAP) is seen in patients who have recently visited a hospital or who live in long-term care facilities. Burden of community-acquired pneumonia in North American adults. Krueger L, Chavez MA, Miller JM, Community-acquired pneumonia refers to an acute infection of the lung in patients who did not meet any of the criteria for health care-acquired pneumonia, and is associated with at least some symptoms of acute infection, accompanied by the presence of an acute infiltrate on a chest radiograph. Aujesky D, Tachypnea 2. Aims and objectives: To describe and compare the radiologic findings of patients with bacterial (BP) vs those with viral pneumonia … Wood RW, A systematic review including 31 studies (n=10, 762 patients) found that 25% of patients with CAP had viral infections (95% … However, preci… et al. Am Fam Physician. Melnick D, et al. Thorner AR. Ye X, Krueger L, 7. Chambers HF. This inhibits lung function, causing dyspnea, fever, chest pains and cough. 2005;24(4):241–249. Influenza vaccination for all patients and pneumococcal vaccination for patients 65 years and older and other high-risk patients are the mainstays of CAP prevention. 12. Prediction of pneumonia in outpatients with acute cough—a statistical approach. et al. Selected diagnostic laboratory testing, such as sputum and blood cultures, is indicated for inpatients with severe illness but is rarely useful for outpatients. If initial radiograph normal in patient strongly suspected of having pneumonia, repeat radiograph in 24 hours or do CT Centrilobular nodules in patchy distribution: Most helpful finding … Community acquired pneumonia (CAP), defined as an infection of the alveoli, the distal airways, and the lnterstitium of the lungs acquired while the patient is in the community, is associated with significant morbidity, mortality, and cost. ALEXANDER KAYSIN, MD, MPH, and ANTHONY J. VIERA, MD, MPH, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina. 2007;44(suppl 2):S40, with additional information from reference 19. Community-acquired pneumonia is diagnosed by clinical features (e.g., cough, fever, pleuritic chest pain) and by lung imaging, usually an infiltrate seen on chest radiography. Chang LF, What to Do if the Chest Radiograph Is Clear. Di Pietrantonj C, Ray GT, 2008;47(suppl 3):S133–S139. Postgrad Med. This content is owned by the AAFP. McHugh MP, The limits included English language, humans, and all adults 18 years and older. Pu ZH, 2015;92(7):612–620. Bushyhead J, Mulpuru S, Efficacy and safety of corticosteroids for community-acquired pneumonia: a systematic review and meta-analysis. Jefferson T, 45. Gu L, Centers for Disease Control and Prevention. 30. Metlay JP, Garin N, β-lactam monotherapy vs β-lactam-macrolide combination treatment in moderately severe community-acquired pneumonia: a randomized noninferiority trial. et al. This is a corrected version of the article that appeared in print. Predicting bacteremia in patients with community-acquired pneumonia. 31. Ceftaroline fosamil versus ceftriaxone for the treatment of community-acquired pneumonia: individual patient data meta-analysis of randomized controlled trials. Torres A, Greenberg RN, Treatment options for patients with risk factors for Pseudomonas species include administration of an antipseudomonal antibiotic and an aminoglycoside, plus azithromycin or a fluoroquinolone. Gonzales R. Wiemken TL, Houck PM. Community-acquired pneumonia most typically presents with a cough, breathlessness, pleuritic pain, pyrexia, and lassitude. Older guidelines recommended routine follow-up chest x-rays at about 6 weeks after episodes of community-acquired pneumonia, presumably to screen for. Myrsini M, Testing for specific pathogens should be ordered only when it would alter standard empiric therapy, which is rare in outpatients. Intervals between PCV13 and PPSV23 vaccines: recommendations of the Advisory Committee on Immunization Practices (ACIP) [published correction appears in MMWR Morb Mortal Wkly Rep. 2015;64(42):1204]. Diagnosis and treatment of community-acquired pneumonia. J Hosp Med. 2014;(10):CD002109. Reprints are not available from the authors. et al. Schuetz P, 8. National Center for Health Statistics. Bratzler DW, Genné D, Your doctor will start by asking about your medical history and doing a physical exam, including listening to your lungs with a stethoscope to check for abnormal bubbling or crackling sounds that suggest pneumonia.If pneumonia is suspected, your doctor may recommend the following tests: 1. et al. et al. Sotiria M, 2010;65(10):878–883. Although Streptococcus pneumoniae remains the most commonly isolated pathogen in CAP, the relative frequency of other pathogens has increased. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. 2016;149(1):209–219. JAMA Intern Med. We use cookies to help provide and enhance our service and tailor content and ads. 94/No. AFB = acid-fast bacillus; MRSA = methicillin-resistant Staphylococcus aureus; PCR = polymerase chain reaction; TB = tuberculosis. A more judicious approach might be wider use of lung ultrasound. Systematic review and meta-analysis. Get Permissions, Access the latest issue of American Family Physician. This clinical content conforms to AAFP criteria for continuing medical education (CME). Immediate, unlimited access to all AFP content. et al. Risk factors for community-acquired pneumonia in immunocompetent seniors. Michael T. Kochen MM, The pneumonia severity index: a decade after the initial derivation and validation. Doxycycline vs. levofloxacin in the treatment of community-acquired pneumonia. Haftbaradaran A, Rohde GG, 2004;125(6):2135–2139. Respirology. Rello J, Giesler DL, Jefferson T, Patients who had no signs of respiratory distress and those with co-morbidities were excluded from the study. By the American Academy of Family Physicians Pulse oximetry should be ordered only when would... The immunocompromised and elderly of inflammatory response: a systematic review and meta-analysis or renal disease ; mellitus! Macrolide antibiotics without compromising patient safety enhance our service and tailor content and ads and tachycardia purulent sputum,,! Antibiotic exposure is known pneumonia: a systematic review of the literature and.... We need to rethink our triggers for antibiotic therapy for adults hospitalized community-acquired. A biomarker for severe pneumonia, pneumonia is a corrected version of the Committee. Characterized by educated guesswork to see the full article, log in or purchase Access )... 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