Summary of Guideline-Expected Culturing and Empiric Antibiotic Inpatient Practice for Community-Acquired Pneumonia
| Recommended Practice . | Nonsevere CAP (Ward) . | Severe CAP (ICU) . |
|---|---|---|
| Culturing | ||
| Obtain respiratory culturesa | No recommendation for/against, except for any of: | Routine |
| a. Empiric treatment for MRSA or PAb | ||
| b. Prior respiratory isolation of MRSA or PA | ||
| c. Clinical risk factors for resistant organismsc | ||
| Obtain blood cultures | Suggest against routinely obtaining, except for any of: | Routine |
| a. Empiric treatment for MRSA or PAb | ||
| b. Prior respiratory isolation of MRSA or PA | ||
| c. Clinical risk factors for resistant organismsc | ||
| Empiric antibiotic selection | ||
| Standard | Routine | Routine |
| Add anti-MRSA | Prior respiratory isolation of MRSA | Prior respiratory isolation of MRSA or clinical risk factors for resistant organismsc |
| Add anti-PA | Prior respiratory isolation of PA | Prior respiratory isolation of PA or clinical risk factors for resistant organismsc |
| Add anti-MRSA and anti-PA | Prior respiratory isolation of MRSA and PA | Prior respiratory isolation of MRSA and PA or clinical risk factors for resistant organismsb |
| Recommended Practice . | Nonsevere CAP (Ward) . | Severe CAP (ICU) . |
|---|---|---|
| Culturing | ||
| Obtain respiratory culturesa | No recommendation for/against, except for any of: | Routine |
| a. Empiric treatment for MRSA or PAb | ||
| b. Prior respiratory isolation of MRSA or PA | ||
| c. Clinical risk factors for resistant organismsc | ||
| Obtain blood cultures | Suggest against routinely obtaining, except for any of: | Routine |
| a. Empiric treatment for MRSA or PAb | ||
| b. Prior respiratory isolation of MRSA or PA | ||
| c. Clinical risk factors for resistant organismsc | ||
| Empiric antibiotic selection | ||
| Standard | Routine | Routine |
| Add anti-MRSA | Prior respiratory isolation of MRSA | Prior respiratory isolation of MRSA or clinical risk factors for resistant organismsc |
| Add anti-PA | Prior respiratory isolation of PA | Prior respiratory isolation of PA or clinical risk factors for resistant organismsc |
| Add anti-MRSA and anti-PA | Prior respiratory isolation of MRSA and PA | Prior respiratory isolation of MRSA and PA or clinical risk factors for resistant organismsb |
Adapted from 2019 American Thoracic Society/Infectious Diseases Society of America guidelines for community-acquired pneumonia [11]. Abbreviations: CAP, community-acquired pneumonia; ICU, intensive care unit; MRSA, methicillin-resistant Staphylococcus aureus; PA, Pseudomonas aeruginosa.
aRespiratory culture indicates Gram stain and culture of sputum, tracheal aspirate, bronchoalveolar lavage specimens, and pleural fluid.
bEmpiric treatment with anti-MRSA or anti-PA therapy selected for some other reason is listed as an indication for obtaining cultures.
cClinical risk factors for resistant organisms include the combination of hospitalization within preceding 90 days and receipt of intravenous antibiotics (not necessarily during the prior hospitalization) within preceding 90 days.
Summary of Guideline-Expected Culturing and Empiric Antibiotic Inpatient Practice for Community-Acquired Pneumonia
| Recommended Practice . | Nonsevere CAP (Ward) . | Severe CAP (ICU) . |
|---|---|---|
| Culturing | ||
| Obtain respiratory culturesa | No recommendation for/against, except for any of: | Routine |
| a. Empiric treatment for MRSA or PAb | ||
| b. Prior respiratory isolation of MRSA or PA | ||
| c. Clinical risk factors for resistant organismsc | ||
| Obtain blood cultures | Suggest against routinely obtaining, except for any of: | Routine |
| a. Empiric treatment for MRSA or PAb | ||
| b. Prior respiratory isolation of MRSA or PA | ||
| c. Clinical risk factors for resistant organismsc | ||
| Empiric antibiotic selection | ||
| Standard | Routine | Routine |
| Add anti-MRSA | Prior respiratory isolation of MRSA | Prior respiratory isolation of MRSA or clinical risk factors for resistant organismsc |
| Add anti-PA | Prior respiratory isolation of PA | Prior respiratory isolation of PA or clinical risk factors for resistant organismsc |
| Add anti-MRSA and anti-PA | Prior respiratory isolation of MRSA and PA | Prior respiratory isolation of MRSA and PA or clinical risk factors for resistant organismsb |
| Recommended Practice . | Nonsevere CAP (Ward) . | Severe CAP (ICU) . |
|---|---|---|
| Culturing | ||
| Obtain respiratory culturesa | No recommendation for/against, except for any of: | Routine |
| a. Empiric treatment for MRSA or PAb | ||
| b. Prior respiratory isolation of MRSA or PA | ||
| c. Clinical risk factors for resistant organismsc | ||
| Obtain blood cultures | Suggest against routinely obtaining, except for any of: | Routine |
| a. Empiric treatment for MRSA or PAb | ||
| b. Prior respiratory isolation of MRSA or PA | ||
| c. Clinical risk factors for resistant organismsc | ||
| Empiric antibiotic selection | ||
| Standard | Routine | Routine |
| Add anti-MRSA | Prior respiratory isolation of MRSA | Prior respiratory isolation of MRSA or clinical risk factors for resistant organismsc |
| Add anti-PA | Prior respiratory isolation of PA | Prior respiratory isolation of PA or clinical risk factors for resistant organismsc |
| Add anti-MRSA and anti-PA | Prior respiratory isolation of MRSA and PA | Prior respiratory isolation of MRSA and PA or clinical risk factors for resistant organismsb |
Adapted from 2019 American Thoracic Society/Infectious Diseases Society of America guidelines for community-acquired pneumonia [11]. Abbreviations: CAP, community-acquired pneumonia; ICU, intensive care unit; MRSA, methicillin-resistant Staphylococcus aureus; PA, Pseudomonas aeruginosa.
aRespiratory culture indicates Gram stain and culture of sputum, tracheal aspirate, bronchoalveolar lavage specimens, and pleural fluid.
bEmpiric treatment with anti-MRSA or anti-PA therapy selected for some other reason is listed as an indication for obtaining cultures.
cClinical risk factors for resistant organisms include the combination of hospitalization within preceding 90 days and receipt of intravenous antibiotics (not necessarily during the prior hospitalization) within preceding 90 days.
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