Table 3.
Diagnostic stewardship in community-acquired pneumonia. Based on references [34,35,36] and on the authors’ own experience.
| Setting | Microbiological Tests | Recommendation |
|---|---|---|
| Primary care, outpatient clinic, long-term facilities | -Rapid antigen-antigen-based diagnostic tests for virus | -Not recommended with the exception of SARS-CoV-2 |
| -Sputum culture | -Not recommended | |
| -Blood culture | -Not recommended | |
| -Molecular tests for detection of bacterial and viral pathogens | -Not recommended | |
| -Use of CRP/procalcitonin | -Not recommended | |
| Emergency department | Rapid antigen-antigen-based diagnostic tests for virus | Not recommended with the exception of SARS-CoV-2 |
| Gram stain and culture of respiratory secretions. | Recommended in patients with severe disease, immunocompromised patients, and in inpatients empirically treated for MRSA or P. aeruginosa | |
| Blood culture | Recommended in patients with severe disease, immunocompromised patients, and in inpatients empirically treated for MRSA or P. aeruginosa | |
| Nares screening for MRSA | Recommended in inpatients empirically treated for MRSA. | |
| Urinary antigen test (S. pneumoniae and Legionella pneumophila) | Recommended in patients with severe CAP and in those with epidemiological risk factors for L. pneumophila infection | |
| Molecular tests for detection of bacterial and viral pathogens | Recommended in patients with severe CAP for the detection of influenza viruses and SARS-CoV-in immunocompromised patients. Recommended detection of influenza viruses in periods of high influenza activity Rapid respiratory syndromic panels may be considered in certain patients |
|
| Use of procalcitonin | Not recommended to determine initiation of antibacterial therapy |