ATS GUIDELINES Bundle

Community Acquired Pneumonia in Adults

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3 Diagnosis 1. Gram Stain ➤ We recommend NOT obtaining sputum Gram stain and culture routinely in adults with CAP managed in the outpatient setting (strong recommendation, very low quality of evidence). ➤ We recommend obtaining pretreatment Gram stain and culture of respiratory secretions in adults with CAP managed in the hospital setting who: 1. are classified as severe CAP (see Table 1), especially if they are intubated (strong recommendation, very low quality of evidence) or a. are being empirically treated for MRSA or P. aeruginosa (strong recommendation, very low quality of evidence), or b. were previously infected with MRSA or P. aeruginosa, especially those with prior respiratory tract infection (conditional recommendation, very low quality of evidence), or c. were hospitalized and received parenteral antibiotics in the last 90 days (conditional recommendation, very low quality of evidence). 2. Blood Cultures ➤ We recommend NOT obtaining blood cultures in adults with CAP managed in the outpatient setting (strong recommendation, very low quality of evidence). ➤ We suggest NOT routinely obtaining blood cultures in adults with CAP managed in the hospital setting (conditional recommendation, very low quality of evidence). ➤ We recommend obtaining pretreatment blood cultures in adults with CAP managed in the hospital setting who: 1. are classified as severe CAP (see Table 1) (strong recommendation, very low quality of evidence), or a. are being empirically treated for MRSA or P. aeruginosa (strong recommendation, very low quality of evidence), or b. were previously infected with MRSA or P. aeruginosa, especially those with prior respiratory tract infection (conditional recommendation, very low quality of evidence), or c. were hospitalized and received parenteral antibiotics, whether during the hospitalization event or not, in the last 90 days (conditional recommendation, very low quality of evidence). 2. 2.

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