Iwasaki K, Paul M. We use cookies to help provide and enhance our service and tailor content and ads. Kapoor WN, Community-acquired pneumonia is defined as pneumonia that is acquired outside the hospital. The limits included English language, humans, and all adults 18 years and older. chest X-ray; community acquired pneumonia (CAP) some chest X-ray appearances of particular conditions; guidance for urgent referral for a chest X-ray; timing as to when to repeat a chest xray (CXR) if consolidation or infection on chest x-ray film et al. Common Questions About Pneumonia in Nursing Home Residents. Initial evaluation should determine the need for hospitalization versus outpatient management using validated mortality or severity prediction scores. Welham SA; File TM Jr, Diagnosis is suggested by a history of cough, dyspnea, pleuritic pain, … Chang LF, Pneumonia … afpserv@aafp.org for copyright questions and/or permission requests. 2015; 127:6, 607-615. Lee JS, Gonzales R. Qu JX, This clinical content conforms to AAFP criteria for continuing medical education (CME). ; Alleyne L, Diagnostic tests for agents of community-acquired pneumonia. Infection. Ebell MH. 2016;315(6):593–602. Clin Infect Dis. / afp Community-acquired pneumonia. Centers for Disease Control and Prevention. The diagnosis of community-acquired pneumonia (CAP) is made when a patient has symptoms of a respiratory infection, a compatible physical examination, and a new lung infiltrate on chest radiograph. Haftbaradaran A, High discordance of chest x-ray and computed tomography for detection of pulmonary opacities in ED patients: implications for diagnosing pneumonia. note: Any major criterion is an absolute indication for admission to an intensive care unit. 2014;20(11):1795–1802. Am Fam Physician. Although oral doxycycline is not included in existing guidelines, observational studies show that it has similar effectiveness as levofloxacin (Levaquin) alone or in combination with ceftriaxone in the inpatient, non-ICU setting, and is associated with fewer Clostridium difficile infections.39,40,43,44 Trials of a new cephalosporin (ceftaroline [Teflaro]) show promising results, although treatment should be reserved for patients with highly resistant gram-positive organisms.38, Inpatient, ICU. MMWR Morb Mortal Wkly Rep. Fine MJ. Metlay JP, Waterer GW, Long AC, et al. 1. 10. Rello J, Address correspondence to Alexander Kaysin, MD, MPH, University of North Carolina at Chapel Hill, 590 Manning Dr., Chapel Hill, NC 27599 (e-mail: alexander_kaysin@med.unc.edu). 1997;278(17):1440–1445. 16. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Pneumonia is a type of lung infection. Rello J, For patients with severe CAP, use of corticosteroids within 36 hours improves outcomes. Rudin M, Broulette J, Risk factors include older age and medical comorbidities. Zhang S. … Greenwald JL. Adapted with permission from Mandell LA, Wunderink RG, Anzueto A, et al. In 41 patients, a final diagnosis of community-acquired pneumonia (CAP) … Schuetz P, Reyburn SW. Velez JA, Copyright © 2016 by the American Academy of Family Physicians. Patients with severe CAP who are admitted to the ICU—about 10% of patients hospitalized with CAP—should receive dual antibiotic therapy, which has been shown to improve survival6,7,43  (Table 66,36–40). Algorithm for imaging in patients with suspected CAP seen in the hospital. Lung ultrasound and chest x-ray for detecting pneumonia in an acute geriatric ward. Across four studies, the most predictive findings were fever greater than 100°F (37.8°C) (positive likelihood ratio [LR+] is approximately 2.7) and egophony (LR+ = 5.3).13  Clinical prediction rules that combine symptoms and examination findings (Table 214) can be helpful in generating a likelihood ratio that can be applied to patients with different prior probabilities of CAP and aid in diagnosis and management.14, Scoring and likelihood ratios of pneumonia. Evidence is lacking on the optimum antibiotic regimen for treatment of CAP in the outpatient setting.41 In the absence of significant comorbidities, macrolides (e.g., azithromycin [Zithromax]) should be used for outpatient therapy of adult CAP, with doxycycline as an alternative, because S. pneumoniae and atypical pathogens account for most cases of CAP, especially in North America.6,16 Exposure to antibiotics in the preceding three months or presence of comorbid illness necessitates the preferential use of fluoroquinolones followed by a beta-lactam antibiotic (e.g., high-dose amoxicillin, amoxicillin-clavulanate [Augmentin], cefuroxime [Ceftin], cefpodoxime) combined with a macrolide as an alternative. ProHOSP Study Group. Procalcitonin to initiate or discontinue antibiotics in acute respiratory tract infections. Raz-Pasteur A, Fluoroquinolones or macrolides alone versus combined with β-lactams for adults with community-acquired pneumonia: systematic review and meta-analysis. 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. What to Do if the Chest Radiograph Is Clear. Charles PG, Given the risk of pneumococcal resistance, an antibiotic from a different class should be used when recent antibiotic exposure is known. Rudin M, 35. 11. Adapted with permission from Mandell LA, Wunderink RG, Anzueto A, et al. Kochen MM, 2011;83(11):1299–1306. 2004;125(6):2135–2139. Anaerobic coverage should be considered if risk factors are present, including aspiration, stroke with bulbar symptoms, alcoholism, and loss of consciousness. Metlay JP, Wunderink RG, Systematic review and meta-analysis. note: All criteria should be met for at least 24 hours before switching to oral antibiotics. Wolfe R, Krueger L, Community-acquired pneumonia. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Jackson LA. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. The incidence rate and economic burden of community-acquired pneumonia in a working-age population. 2015;17(11):48. Groot T, Administration of corticosteroids within 36 hours of hospital admission for patients with severe community-acquired pneumonia decreases the risk of adult respiratory distress syndrome and length of treatment. McHugh MP, A number of international guidelines recommend a chest radiograph (x-ray) is obtained when pneumonia … 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]. Demicheli V. et al. Groot T, Park H, Lim WS, Flanders SA, Table 5 summarizes the more widely adopted CURB-65 and CRB-65 prediction scores,6,31 which have greater ease of use, but weaker predictive power for 30-day mortality.24,31,32 Among low-risk patients (Pneumonia Severity Index class less than 3 or CURB-65 score less than 2), the LR− for 30-day mortality using the index is 0.08, and 0.21 using CURB-65.31 Sensitivity for predicting ICU admission was reported as 74% vs. 39% to 50% for Pneumonia Severity Index vs. CURB-65, respectively.24,32, Prognostic variables (assign 1 point for each variable), Urea nitrogen level > 20 mg per dL (7.14 mmol per L)*, Blood pressure (systolic < 90 mm Hg or diastolic ≤ 60 mm Hg). et al. Bregenzer T, It doesn’t happen in a … Community-acquired pneumonia (CAP) remains a common condition associated with considerable morbidity and mortality. Su LX, 2010;138(1):121–129. Antibiotic therapy for adults hospitalized with community-acquired pneumonia: a systematic review. et al. Blood tests are used to confirm an infection and to try to identify the type of organism causing the infection. Corticosteroid therapy for patients hospitalized with community-acquired pneumonia: a systematic review and meta-analysis. et al. HIV = human immunodeficiency virus; MRSA = methicillin-resistant Staphylococcus aureus. 24. Lim WS, Efficacy and safety of corticosteroids for community-acquired pneumonia: a systematic review and meta-analysis. Pneumonia is a general term in widespread use, defined as infection within the lung. Use of 13-valent pneumococcal conjugate vaccine and 23-valent pneumococcal polysaccharide vaccine for adults with immunocompromising conditions: recommendations of the Advisory Committee on Immunization Practices (ACIP). Sibila O, 33. 14. Restrepo MI, Severity assessment tools for predicting mortality in hospitalised patients with community-acquired pneumonia. Xiao K, Chalmers JD. Briel M, Demicheli V. Comprehensive molecular testing for respiratory pathogens in community-acquired pneumonia. 9(November 1, 2016) Emerg Infect Dis. Burden of community-acquired pneumonia in North American adults. However, most patients exhibit at least one respiratory symptom; acute functional or cognitive decline; or repeat temperatures of 99°F (37.2°C) or greater.15. Alonso-Coello P, Antibiotic therapy for adults hospitalized with community-acquired pneumonia: a systematic review. 41. 22. A number of international guidelines recommend a chest radiograph (x-ray) … The most commonly identified pathogens are Streptococcus pneumoniae, Haemophilus influenzae, atypical bacteria (ie, Chlamydia pneumoniae, Mycoplasma pneumoniae, Legionella species), and viruses. Clinical suspicion should be driven by comorbidities and other risk factors (Table 1).6,9–11 Commonly used diagnostic methods may identify a pathogen in only 30% to 40% of patients.12, Anaerobic oral flora, Klebsiella pneumoniae, Mycobacterium tuberculosis, Streptococcus pneumoniae, Bacillus anthracis (anthrax), Francisella tularensis (tularemia), Yersinia pestis (plague), Chronic obstructive pulmonary disease or smoking, Chlamydophila pneumoniae, Haemophilus influenzae, Legionella species,9,10 Moraxella catarrhalis, Pseudomonas aeruginosa or other gram-negative rods, S. pneumoniae, Exposure to farm animals or parturient cats, H. influenzae, M. tuberculosis, S. pneumoniae, Aspergillus and Cryptococcus species, H. capsulatum, H. influenzae, Nocardia species, nontuberculous mycobacteria, Pneumocystis jiroveci, Hotel or cruise ship travel in past two weeks, H. influenzae, influenza and other respiratory viruses, S. pneumoniae, Staphylococcus aureus (including MRSA), Anaerobes, M. tuberculosis, S. aureus (including MRSA), S. pneumoniae, Anaerobic oral flora, M. tuberculosis, nontuberculous mycobacteria, S. aureus (including MRSA), Travel to or residence in Southeast Asia and East Asia, Avian influenza, severe acute respiratory syndrome, Travel to or residence in southeastern and south-central states bordering the Mississippi and Ohio River basins, Travel to or residence in southwestern United States. Akram AR, 2014;(10):CD002109. Ellington LE, Shams N, Chiappa V, Systematic review and meta-analysis. Gierke R, ALEXANDER KAYSIN, MD, MPH, and ANTHONY J. VIERA, MD, MPH, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina. Worldwide, pneumonia is the leading cause of death in children aged < 5 years. At this time, we need to rethink our triggers for antibiotic use in suspected CAP (, /cms/asset/8b6aaa53-d7ae-42e3-a19e-5563756c494c/mmc1.mp3. Christ-Crain M, Kobayashi M, Henley E, Observational data suggest lower short-term mortality when antibiotic therapy is administered within four to eight hours of hospital arrival in patients with moderate or severe pneumonia.36  Table 7 provides recommended criteria for transitioning patients from intravenous to oral antibiotics.36, Heart rate < 100 beats per minute and systolic blood pressure > 90 mm Hg, Oxygen saturation > 90%, arterial oxygen partial pressure > 60 mm Hg on room air or with low-flow supplemental oxygen via nasal cannula, or return to baseline oxgen level for patients receiving long-term oxygen therapy. / Journals et al. Gadsby NJ, Kan QC. Community-acquired pneumonia visualized on CT scans but not chest radiographs: pathogens, severity and clinical outcomes. Chang LF, 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. 2010;122(2):130–141. MMWR Morb Mortal Wkly Rep. Beijing Network for Adult Community-Acquired Pneumonia (BNACAP). Published by Elsevier Inc. All rights reserved. 30. Urine antigen testing may be useful in select patients, especially if adequate sputum cannot be obtained or antibiotics were given, because antigen can be detected starting on the first day of illness and for several weeks thereafter.6,23 Pneumococcal urine antigen testing has a sensitivity of 60% to 80% and specificity greater than 90%, whereas Legionella testing has a sensitivity of 70% to 90% and specificity of 99% for serogroup 1, which accounts for 80% to 95% of Legionella-associated CAP.6  Testing is most useful in critically ill patients and in the scenarios listed in Table 3.6,19, The overall rate of pathogen detection among patients with CAP is 30% to 40%.12 Recent developments allow use of rapid multiorganism polymerase chain reaction–based testing for pathogen-directed treatment, with bacterial and viral detection rates as high as 86%.9,19 Such detection can potentially result in earlier de-escalation of therapy and decreased reliance on broad-spectrum antimicrobials.11,24 Additionally, because viral etiologies account for about 25% of all CAP cases, utilization of rapid viral respiratory panels can be useful to tailor treatment and limit antibiotic exposure.6,24–26, Although more readily available through newer polymerase chain reaction–based methods, routine testing for other atypical pathogens (e.g., Chlamydophila pneumoniae, Mycoplasma pneumoniae) in patients with CAP is not currently recommended.6,11,19, To improve patient outcomes and reduce unnecessary antibiotic exposure, procalcitonin is being studied as a potential biomarker of severe CAP. Bariatric Surgery to Prevent COPD Exacerbations? Bordon JM, Yu H, Predicting pneumonia in adults with respiratory illness. JAMA. Procalcitonin algorithms for antibiotic therapy decisions: a systematic review of randomized controlled trials and recommendations for clinical algorithms. We use cookies to help provide and enhance our service and tailor content and ads. Frei C, Address correspondence to Alexander Kaysin, MD, MPH, University of North Carolina at Chapel Hill, 590 Manning Dr., Chapel Hill, NC 27599 (e-mail: Broulette J, 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. Mulpuru S, Zhang SG, Direct medical costs and utilization of health care services to treat pneumonia in the United States: an analysis of the 2007–2011 Medical Expenditure Panel Survey. SMART-COP: a tool for predicting the need for intensive respiratory or vasopressor support in community-acquired pneumonia. Data Sources: A PubMed search was completed in Clinical Queries using the key term community-acquired pneumonia. 2011;29(18):3398–3412. Krueger L, Russell CD, Int J Antimicrob Agents. 42. 2014;15:50. Smith DL, When there is high clinical suspicion of pneumonia and the chest x-ray does not reveal an infiltrate, doing computed tomography (CT) or repeating the chest x-ray in 24 to 48 hours is recommended. Rivetti D, Sibila O, This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Rascati KL. 49. Clin Infect Dis. Greenberg RN, Effect of corticosteroids on treatment failure among hospitalized patients with severe community-acquired pneumonia and high inflammatory response: a randomized clinical trial. et al. ; Am Fam Physician. Sun TW, Chest. Pyenson B, Welham SA; Clin Infect Dis. Ferrer M, Liu ZQ, 94/No. What imaging studies will be helpful in making or excluding the diagnosis of community-acquired pneumonia? Tompkins RK. 2015;163(7):519–528. Efficacy and effectiveness of influenza vaccines in elderly people: a systematic review [published correction appears in. Community-acquired pneumonia is defined as pneumonia that is acquired outside the hospital. Clin Infect Dis. et al. In community-acquired pneumonia (CAP), you get infected in a community setting. British Thoracic Society. Tachypnea 2. Copyright © 2021 Elsevier Inc. except certain content provided by third parties. Schuetz P, Doernberg SB, Ray GT, Jansen HM, Chen B, Doctors diagnose community-acquired pneumonia by listening to the lungs with a stethoscope and by reading x-rays or computed tomography (CT) scans of the chest. ; Chalmers JD, et al. By continuing you agree to the Use of Cookies. Postgrad Med. Houck PM. FiO2 = fraction of inspired oxygen; PaO2 = partial arterial oxygen pressure. Worldwide, pneumonia is the leading cause of death in children aged < 5 years. Lung imaging with chest radiography has been the standard method of diagnosing pneumonia6 (Figure 1). Raz-Pasteur A, Metlay JP, Rascati KL. / Vol. Doernberg SB, It is due to material, usually purulent, filling the alveoli. 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. 15. Effectiveness of ceftriaxone plus doxycycline in the treatment of patients hospitalized with community-acquired pneumonia. 46. For patients with severe community-acquired pneumonia, corticosteroids decrease the risk of adult respiratory distress syndrome and modestly reduce intensive care unit and hospital stays, duration of intravenous antibiotic treatment, and time to clinical stability without increasing major adverse events. Anzueto A. The diagnosis of community-acquired pneumonia (CAP) is made when a patient has symptoms of a respiratory infection, a compatible physical examination, and a new lung infiltrate on chest radiograph. When there is high clinical suspicion of pneumonia and the chest x-ray does not reveal an infiltrate, doing computed tomography (CT) or repeating the chest x-ray in 24 to 48 hours is recommended. Lutfiyya MN, 2008;47(suppl 3):S133–S139. Guan W, Fine MJ. Rales heard over the involved lobe or segment 3. Prediction of pneumonia in outpatients with acute cough—a statistical approach. Doxycycline vs. levofloxacin in the treatment of community-acquired pneumonia. Diagnosis is suggested by a history of cough, dyspnea, pleuritic pain, or acute functional or cognitive decline, with abnormal vital signs (e.g., fever, tachycardia) and lung examination findings. JAMA Intern Med. Müller B, Alonso-Coello P, Wise MP, 18. Chavez MA, Iwasaki K, 47. Ravakhah K. Zadeikis N, N Engl J Med. Mulpuru S, Dudas V, Vlaspolder F, British Thoracic Society. The pneumonia severity index: a decade after the initial derivation and validation. 32. Kochen MM, Kapoor WN, AFB = acid-fast bacillus; MRSA = methicillin-resistant Staphylococcus aureus; PCR = polymerase chain reaction; TB = tuberculosis. Schuetz P, et al. Zhang SG, Bushyhead J, Thorner AR. CAP may be caused by bacteria, viruses, or fungi. It is important to remember that these symptoms, whilst classical, can be subdued/absent, especially in the immunocompromised and elderly. Rohde GG, Jackson ML, SMART-COP: a tool for predicting the need for intensive respiratory or vasopressor support in community-acquired pneumonia. CAP is common, affecting people of all ages, and its symptoms occur as a result of oxygen-absorbing areas of the lung (alveoli) filling with fluid. Marrie TJ. Symptoms and signs are fever, cough, sputum production, pleuritic chest … Alleyne L, We have known for some time that some patients with respiratory infection symptoms and a negative chest radiograph can have infiltrates on chest CT scan.1 However, … Shams N, Di Pietrantonj C, Melnick D, Clin Infect Dis. et al. Schembri S, Clin Infect Dis. [corrected], Pulse oximetry should be assessed in all patients with possible CAP. 2007;44(suppl 2):S38, with additional information from reference 20. Anzueto A, 2015;92(7):612–620. Park H, et al. Abers MS, 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. Beijing Network for Adult Community-Acquired Pneumonia (BNACAP). Healthcare utilization and cost of pneumococcal disease in the United States. Giesler DL, †—Antibiotic from a different class should be used. Value of intensive diagnostic microbiological investigation in low- and high-risk patients with community-acquired pneumonia. Adapted with permission from Mandell LA, Wunderink RG, Anzueto A, et al. Anzueto A, Fine MJ. Yu VL, Together, influenza and pneumonia are the eighth leading cause of mortality among adults in the United States and result in more than 60,000 deaths annually.1–4 Community-acquired pneumonia (CAP) disproportionately affects persons who are very young or very old, with an annual incidence of 9.2 to 33 per 1,000 person-years.1,5 Out of an estimated 878,000 adults 45 years and older who were hospitalized with a primary diagnosis of CAP in 2010, 71% were 65 years or older, and 10% to 20% required admission to the intensive care unit (ICU).1,2,6,7 Pneumococcal pneumonia alone was responsible for 866,000 outpatient visits in 2004.8 In the United States, annual health care costs associated with CAP range from $10.6 to $17 billion and are expected to grow as the proportion of older persons increases.1,2,4 Inpatient care accounts for more than 90% of pneumonia-related health expenditure.2,3,5. Gonzales R. Ceftaroline fosamil versus ceftriaxone for the treatment of community-acquired pneumonia: individual patient data meta-analysis of randomized controlled trials. High-resolution computed tomography for the diagnosis of community-acquired pneumonia. Patients who had no signs of respiratory distress and those with co-morbidities were excluded from the study. Initial outpatient therapy should incl… Burden of community-acquired pneumonia in North American adults. Chavez MA, Managing CAP in the ICU. Bordon JM, 2007;76(4):560–562. Validated prediction scores for pneumonia severity can guide the decision between outpatient and inpatient therapy. Pneumonia. Vaccine. Genné D, Does this patient have community-acquired pneumonia? 2015;46(3):242–248. Müller F, Rivetti A, Zadeikis N, A guide to utilization of the microbiology laboratory for diagnosis of infectious diseases: 2013 recommendations by the Infectious Diseases Society of America (IDSA) and the American Society for Microbiology (ASM). Chen B, Patients with CAP who are admitted to the intensive care unit should be treated with dual antibiotic therapy. 29. Bratzler DW, Pneumonia. Clin Infect Dis. Viruses are the most common cause of pneumonia, but viral and bacterial infections do coexist, and antibiotic management is made more challenging by variable rates of antibiotic resistance in communities, Sawyer reminds us. 2013;57(4):e22–e121. Healthcare utilization and cost of pneumococcal disease in the United States. Briel M, The incidence rate and economic burden of community-acquired pneumonia in a working-age population. Early chest computed tomography scan to assist diagnosis and guide treatment decision for suspected community-acquired pneumonia. Gu L, A chest x-ray (preferably PA and lateral) should be obtained in all patients suspected of … Charles PG, Melnick D, Simplification of the IDSA/ATS criteria for severe CAP using meta-analysis and observational data. Velez JA, Chalmers JD, J Hosp Med. Sign up for the free AFP email table of contents. Paul M. Immediate, unlimited access to all AFP content. In 1998, a Scandinavian study evaluated 47 patients (including 28 outpatients) with symptoms of respiratory infection who had both a chest radiograph and a CT scan. Rivetti D, A systematic review of 14 randomized controlled trials examining use of procalcitonin testing in European settings found a reduction in antibiotic prescribing in low-acuity settings and shorter duration of therapy in higher-acuity settings (i.e., emergency department and ICU) when results of high-sensitivity (detection limit 0.1 ng per mL) procalcitonin assays were used in clinical decision making.30 Further research is needed to evaluate the impact of procalcitonin testing among patients with acute respiratory illnesses in terms of patient-oriented outcomes, antibiotic exposure, and cost-effectiveness in U.S. populations. Diagnosing Pneumonia on Chest X-Ray Dec 20, 2019 | 5 comments Pneumonia, which is defined as inflammation of the lung, is a common cause of morbidity and mortality around the world. FINANCIAL/NONFINANCIAL DISCLOSURES: None declared. J Antimicrob Chemother. et al. Mokabberi R, A more judicious approach might be wider use of lung ultrasound. 28. Wiemken TL, Centers for Disease Control and Prevention. Salih W, Pu ZH, Comprehensive molecular testing for respiratory pathogens in community-acquired pneumonia. Diagnosing pneumonia by history and physical examination. In patients with suspected CAP, chest radiography or lung ultrasonography should be performed to confirm the diagnosis. et al. Use of procalcitonin testing can assist in the management of CAP and reduce antibiotic exposure without compromising patient safety. Crit Care. Adults 65 years and older should routinely receive the 13-valent pneumococcal conjugate vaccine (PCV13; Prevnar 13) and the 23-valent pneumococcal polysaccharide vaccine (PPSV23; Pneumovax 23), preferably PCV13 first followed by PPSV23 in 12 months. The most commonly identified pathogens are Streptococcus pneumoniae, Haemophilus influenzae, atypical bacteria (ie, Chlamydia pneumoniae, Mycoplasma pneumoniae, Legionella species), and viruses. Risk factors for community-acquired pneumonia in immunocompetent seniors. Wolcott B, Liu D, 4. Chambers HF. Often accompanying the symptoms, are clinical signs, including tachypnea and tachycardia. Akram AR, Efficacy and effectiveness of influenza vaccines in elderly people: a systematic review [published correction appears in Lancet. Ma A, Jackson LA. Clinical diagnosis is based on a group of signs and symptoms related to lower … et al. Eur J Clin Microbiol Infect Dis. Eur Respir J. There is usually considerable overlap. This inhibits lung function, causing dyspnea, fever, chest pains and cough. Increased tactile fremitus, bronchial breath sounds, and egophony may be present if consolidation has … Testing for specific pathogens should be ordered only when it would alter standard empiric therapy, which is rare in outpatients. 17. de Graaff CS,