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Diagnostic approach to community-acquired pneumonia in adults

INTRODUCTION

Community-acquired pneumonia (CAP) is defined as an acute infection of the pulmonary parenchyma in a patient who has acquired the infection in the community, as distinguished from hospital-acquired (nosocomial) pneumonia. A third category of pneumonia, designated "healthcare-associated pneumonia," is acquired in other healthcare facilities such as nursing homes, dialysis centers, and outpatient clinics or within 90 days of discharge from an acute or chronic care facility [1]. (See "Epidemiology, pathogenesis, microbiology, and diagnosis of hospital-acquired, ventilator-associated, and healthcare-associated pneumonia in adults".)

CAP is a common and potentially serious illness. It is associated with considerable morbidity and mortality, particularly in elderly patients and those with significant comorbidities [2]. (See "Prognosis of community-acquired pneumonia in adults".)

The diagnostic approach to CAP in immunocompetent adults will be reviewed here. A variety of other important issues related to CAP are discussed separately. These include:

CLINICAL EVALUATION

The approach to the patient with community-acquired pneumonia (CAP) begins with the clinical evaluation followed by chest radiograph with or without microbiologic testing. A systematic review highlighted the lack of sensitivity of the clinical criteria for an accurate diagnosis of CAP; even a combination of symptoms (cough) and signs (fever, tachycardia, and crackles) did not have a sensitivity above 50 percent when using chest x-ray as the standard [3].

                      

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Literature review current through: Apr 2013. | This topic last updated: Oct 9, 2012.
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