Microbiology Tests

• Sputum gram stain should demonstrate the presence of WBCs and the absence of squamous epithelial cells. It may or may not show a predominance of one type of organism

• Sputum culture and susceptibility are not obtained in the outpatient setting. The value of culturing is debated owing to the rapidity in which S. pneumoniae dies in transport media and the inability to reliably or routinely culture atypical organisms

• Bronchoscopy may be performed to improve the ability to diagnose pneumonia. Tracheal secretions often are better specimens than sputum owing to the lack of oral contamination

• Serology (IgM and IgG) is useful in determining the presence of atypical organisms such as Mycoplasma and Chlamydia

• Urinary direct fluorescence antigen (DFA) is used to diagnose L. pneumophila

• Polymerase chain reaction (PCR) is being used more frequently to detect the DNA of respiratory pathogens

• Blood cultures must be obtained in all patients hospitalized with pneumonia to comply with Joint Commission on Accreditation of Healthcare Organizations (JCAHO) pneumonia guidelines. Positive blood cultures are present in about 1% to 20% of patients with CAP

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