Diagnosis and Assessment
Diagnostic Testing Microbiologic Testing Blood Cultures: Outpatient
ÎBlood cultures should NOT be routinely performed in nontoxic, fully immunized children with CAP managed in the outpatient setting. (SR-M)
ÎBlood cultures should be obtained in children who fail to demonstrate clinical improvement and in those who have progressive symptoms or clinical deterioration following initiation of antibiotic therapy. (SR-M)
Blood Cultures: Inpatient
ÎBlood cultures should be obtained in children requiring hospitalization for presumed bacterial CAP that is moderate to severe, particularly those with complicated pneumonia. (SR-L)
ÎIn improving patients who otherwise meet criteria for discharge, a positive blood culture with identification or susceptibility results pending should NOT routinely preclude discharge of that patient on appropriate oral or intravenous antimicrobial therapy. The patient can be discharged if close follow-up is assured. (WR-L)
Follow-up Blood Cultures
ÎRepeat blood cultures in children with clear clinical improvement are not necessary to document resolution of pneumococcal bacteremia. (WR-L)
ÎRepeat blood cultures to document resolution of bacteremia should be performed in children with bacteremia caused by S. aureus, regardless of clinical status. (SR-L)
Sputum Gram Stain and Culture
ÎSputum samples for culture and Gram stain should be obtained in hospitalized children who can produce sputum. (WR-L)
Urinary Antigen Detection Tests
ÎUrinary antigen detection tests are NOT recommended for the diagnosis of pneumococcal pneumonia in children; false-positive tests are common. (SR-H)
Testing For Viral Pathogens
ÎSensitive and specific tests for the rapid diagnosis of influenza virus and other respiratory viruses should be used in the evaluation of children with CAP. (SR-H)
Note: A positive influenza test may both decrease the need for additional diagnostic studies and decrease antibiotic use, while guiding appropriate use of antiviral agents in both outpatient and inpatient settings.
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