The document discusses tests for determining the cause of community-acquired pneumonia (CAP), including inflammatory marker tests like procalcitonin that have not established cutoff levels to distinguish bacterial from viral infections. Polymerase chain reaction (PCR) tests for influenza are recommended during flu season but not otherwise. Nasal swab tests for methicillin-resistant Staphylococcus aureus (MRSA) have high specificity and can rule out MRSA pneumonia if negative, allowing suspension of MRSA coverage for CAP treatment.
The document discusses tests for determining the cause of community-acquired pneumonia (CAP), including inflammatory marker tests like procalcitonin that have not established cutoff levels to distinguish bacterial from viral infections. Polymerase chain reaction (PCR) tests for influenza are recommended during flu season but not otherwise. Nasal swab tests for methicillin-resistant Staphylococcus aureus (MRSA) have high specificity and can rule out MRSA pneumonia if negative, allowing suspension of MRSA coverage for CAP treatment.
The document discusses tests for determining the cause of community-acquired pneumonia (CAP), including inflammatory marker tests like procalcitonin that have not established cutoff levels to distinguish bacterial from viral infections. Polymerase chain reaction (PCR) tests for influenza are recommended during flu season but not otherwise. Nasal swab tests for methicillin-resistant Staphylococcus aureus (MRSA) have high specificity and can rule out MRSA pneumonia if negative, allowing suspension of MRSA coverage for CAP treatment.
The document discusses tests for determining the cause of community-acquired pneumonia (CAP), including inflammatory marker tests like procalcitonin that have not established cutoff levels to distinguish bacterial from viral infections. Polymerase chain reaction (PCR) tests for influenza are recommended during flu season but not otherwise. Nasal swab tests for methicillin-resistant Staphylococcus aureus (MRSA) have high specificity and can rule out MRSA pneumonia if negative, allowing suspension of MRSA coverage for CAP treatment.
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Inflammatory Marker Tests
Bacterial etiologies have been associated with higher
serum procalcitonin concentrations, but a cutoff level to distinguish viral from bacterial illness has not been established. Therefore, the IDSA and ATS do not recommend use of procalcitonin levels to determine whether to initiate antibiotic treatment. In addition, serial procalcitonin concentrations are not generally recommended to determine treatment duration; procalcitonin levels may not be increased in patients with bacterial/viral coinfection or in cases of pneumonia caused by Legionella or Mycoplasma spp.
Polymerase Chain Reaction Tests
A rapid influenza PCR is recommended in adult patients with CAP during seasons of increased influenza activity but is not essential when few influenza cases are being reported. Tests for influenza and other respiratory viruses are recommended in pediatric patients with CAP. Refer to the ARUP Consult Influenza topic for guidance about recommended testing.
Nasal Swab for MRSA
Nasal PCR offers high specificity and negative predictive value (NPV) for MRSA pneumonia. In the absence of nasal colonization, MRSA pneumonia is unlikely. Coverage for MRSA pneumonia can often be suspended when the results of nasal swab testing are negative, particularly when CAP is not severe. Nasal culture for MRSA is associated with the same high specificity and NPV and may be less costly than PCR, but PCR yields results more rapidly.