Hospital-acquired pneumonia laboratory findings
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Current guidelines recommend a combination of chest X-ray, laboratory data as well as clinical judgment in diagnosis and management of community acquired pneumonia. Laboratory tests include CBC, metabolic panel, sputum gram-stain and culture, serology for mycoplasma, chlamydia, and legionella. Additional test include bronchial samples and HIV testing for special conditions.
Basic Blood Works
- Complete blood count (leucocytosis). In some people with compromised immunity, the white blood cell count may appear deceptively normal.
- Basic metabolic panel
- Sputum gram stain and culture have poor yield. Sputum culture provides diagnostics information in roughly 1 in 5 patients only.
- Sputum cultures generally take at least two to three days, so they are mainly used to confirm that the infection is sensitive to an antibiotic that has already been started.
- A good sputum sample contains small number of squamous epithelial cells and a large number of PMNs.
- Blood cultures are not recommended for the outpatient management of CAP due to the low yield of pathogens.
- A blood sample may similarly be cultured to look for infection in the blood (blood culture). Any bacteria identified are then tested to see which antibiotics will be most effective.
- Specific blood serology tests for other bacteria (Mycoplasma, Legionella and Chlamydophila) can be done in conditions with strong suspicion of the causative organisms.
Respiratory Samples for VAP
- Tracheo-bronchial aspiration
- Mini-bronchoalveloar lavage
- Tracheobronchial aspiration - > 1 million cfu / mL is
- Bronchoalveolar lavage - > 10,000 cfu / mL
- PSB (protected brush sampling) - > 1,000 cfu / mL
- Report bacterial growth as heavy, moderate, light, or no growth.
- A moderate to heavy growth is suggestive of ventilator associated pneumonia.
- More false positive results compared to quantitative cultures.
- In more severe cases, (bronchoscopy) can be used collect fluid for culture.
- Special tests can be performed if an uncommon microorganism is suspected (such as testing the urine for Legionella antigen when Legionnaires' disease is a concern).
- HIV testing should be performed on all patients presenting with CAP (ages 13 to 75) in a medical setting.
- Respiratory secretions can also be tested for the presence of viruses such as influenza, respiratory syncytial virus, and adenovirus.
Major Points and Recommendations for Laboratory Tests in Adults with Hospital-Acquired, Ventilator-Associated, and Healthcare-Associated Pneumonia 
For Level of evidence and classes click here.
- "Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia". American Journal of Respiratory and Critical Care Medicine. 171 (4): 388–416. 2005. doi:10.1164/rccm.200405-644ST. PMID 15699079. Retrieved 2012-09-13. Unknown parameter