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. 2015 Apr 3:557–582.e22. doi: 10.1016/B978-1-4557-3383-5.00033-6

eTable 33-6.

Recommended Microbiologic Evaluation in Patients with Nonresolving Pneumonia

BLOOD CULTURES (TWO SETS)
URINE
Antigen test for detection of Legionella pneumophila
SPUTUM

  • Gram stain, Giemsa stain, immunofluorescence stains for Legionella; normal and modified Ziehl-Neelsen stain for Mycobacterium spp. and Nocardia spp.

  • Cultures for conventional bacteria, Legionella, mycobacteria, and fungi

BRONCHOSCOPY SPECIMENS (USING PSB OR BAL)*

  • Gram stain, Giemsa stain, immunofluorescence stains for Legionella and Pneumocystis jirovecii; normal and modified Ziehl-Neelsen stain for Mycobacteria spp. and Nocardia spp.

  • Cultures for aerobic and anaerobic bacteria, Legionella, mycobacteria, and fungi

PLEURAL FLUID

  • Gram stain, Giemsa stain, immunofluorescence stains for Legionella; normal and modified Ziehl-Neelsen stain for Mycobacteria spp. and Nocardia spp.

  • Cultures for aerobic and anaerobic bacteria, Legionella, mycobacteria, and fungi

BAL, bronchoalveolar lavage; PSB, protected specimen brush.

*

Quantitative criteria for the interpretation of PSB and BAL specimens are described in the text.