Clinical features |
General
- Cough, fever, pleuritic chest pain, dyspnea, tachypnea, hypoxia, sputum production, leukocytosis/leukopenia; rarely: hemoptysis.
- Crackles, rhonchi, tubular breath sounds, diminished breath sounds or dullness to percussion.
CAP
- Typical: Sudden-onset fever, productive cough, shortness of breath, signs of pulmonary consolidation (dullness, increased fremitus, bronchial breath sounds, crackles), and occasionally, pleuritic chest pain.
- Atypical: Gradual onset, dry cough, shortness of breath, crackles, general myalgias, fatigue.
HAP
- New or progressive pulmonary infiltrate on chest imaging and two of the three following clinical features: fever greater than 38°C, leukocytosis or leukopenia, or purulent secretions.
VAP
- New or progressive pulmonary infiltrate on chest imaging and one or more of the following findings: fever, purulent tracheobronchial secretions, leukocytosis, tachypnea, decreased tidal volume, increased minute ventilation, and decreased oxygenation . Signs and symptoms may develop gradually or suddenly.
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Microbiologic evaluation |
- Sample sources: expectorated sputum, induced sputum, tracheal secretions, alveolar lavage, or pleural fluid.
- Collection: Obtain specimen prior to antibiotic initiation, rinse mouth prior to expectoration, ensure no food intake one to two hours prior to expectoration, and transport specimen promptly to lab.
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