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.
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