{"id":4883,"date":"2022-07-08T15:15:42","date_gmt":"2022-07-08T03:15:42","guid":{"rendered":"https:\/\/www.awanuilabs.co.nz\/central\/wellington\/?page_id=4883"},"modified":"2025-05-05T14:32:45","modified_gmt":"2025-05-05T02:32:45","slug":"community-acquired-pneumonia-cap","status":"publish","type":"page","link":"https:\/\/www.awanuilabs.co.nz\/central\/wellington\/for-referrers\/microbiology\/how-do-i-diagnose\/community-acquired-pneumonia-cap\/","title":{"rendered":"Community-acquired pneumonia (CAP)"},"content":{"rendered":"\n<p><strong>Infection:<\/strong>  community-acquired pneumonia (CAP) &#8211;<\/p>\n\n\n\n<p>Also refer to: <a href=\"https:\/\/www.awanuilabs.co.nz\/central\/wellington\/for-referrers\/microbiology\/best-practice-use-of-common-microbiology-tests\/\">Sputum culture test information<\/a><\/p>\n\n\n\n<div class=\"wp-block-atomic-blocks-ab-accordion ab-block-accordion\"><details><summary class=\"ab-accordion-title\">Brief description:<\/summary><div class=\"ab-accordion-text\">\n<ul>\n<li>One of the commonest infectious conditions leading to hospitalisation, although is commonly over-diagnosed.<\/li>\n\n\n\n<li><em>Streptococcus pneumoniae<\/em> is the most important bacterial cause.<\/li>\n\n\n\n<li>In NZ Legionella is an important cause, particularly in spring and summer, with the commonest species being <em>L. longbeachae<\/em> (often associated with potting mix).<\/li>\n\n\n\n<li>Patients living in rest homes, including \u2018hospital-level care\u2019, should generally be managed as CAP, rather than hospital-acquired pneumonia.<\/li>\n<\/ul>\n<\/div><\/details><\/div>\n\n\n\n<div class=\"wp-block-atomic-blocks-ab-accordion ab-block-accordion\"><details><summary class=\"ab-accordion-title\">Did you know?<\/summary><div class=\"ab-accordion-text\">\n<ul>\n<li>Determining the causative organism for CAP is usually not possible with any degree of certainty. This is because many of the organisms that can cause CAP are also normal inhabitants of the upper respiratory tract, so tend to grow in sputum samples regardless.<\/li>\n\n\n\n<li>Viruses are also likely an under recognised cause of CAP, however, again, differentiating between post-viral upper respiratory tract carriage and pneumonia is difficult.<\/li>\n<\/ul>\n<\/div><\/details><\/div>\n\n\n\n<div class=\"wp-block-atomic-blocks-ab-accordion ab-block-accordion\"><details><summary class=\"ab-accordion-title\"><strong>Diagnostic approach &amp; tests of choice<\/strong>:<\/summary><div class=\"ab-accordion-text\">\n<ul>\n<li>Patients <strong>not requiring admission to hospital<\/strong> generally <strong>do not require<\/strong> any microbiological testing other than for COVID-19.\n<ul>\n<li>Exception: if patient would meet criteria for Oseltamivir, then <strong>influenza testing<\/strong> is recommended. If result will not be available in a timely fashion, it may be appropriate to start Oseltamivir and then stop if influenza PCR is negative.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<ul>\n<li>For adult patients <strong>requiring admission to hospital<\/strong>, these tests are recommended:\n<ul>\n<li>2 sets of <strong>blood cultures <\/strong>before antibiotics<\/li>\n\n\n\n<li>Nasopharyngeal swab for <strong>COVID-19<\/strong> and <strong>influenza PCR<\/strong><\/li>\n\n\n\n<li><strong><a href=\"https:\/\/www.awanuilabs.co.nz\/central\/wellington\/for-referrers\/microbiology\/how-do-i-diagnose\/human-immunodeficiency-virus-hiv\/\">HIV serology<\/a><\/strong><\/li>\n\n\n\n<li>Special situations:\n<ul>\n<li>Strong exposure history for Legionella (e.g. potting mix) send sputum for <a href=\"https:\/\/www.awanuilabs.co.nz\/central\/wellington\/for-referrers\/microbiology\/how-do-i-diagnose\/legionella\/\"><strong>Legionella<\/strong>&nbsp;<strong> PCR<\/strong><\/a><\/li>\n\n\n\n<li>Radiological features of staphylococcal pneumonia (e.g. cavitation) send <strong>sputum for Gram stain and culture<\/strong><\/li>\n\n\n\n<li>Farming\/contaminated water exposures send blood samples for <strong><a href=\"https:\/\/www.awanuilabs.co.nz\/central\/wellington\/for-referrers\/microbiology\/how-do-i-diagnose\/leptospirosis\/\">Leptospirosis&nbsp; serology and PCR<\/a><\/strong><\/li>\n\n\n\n<li>Prolonged symptoms, or suspicious radiological features, send sputum for <strong><a href=\"https:\/\/www.awanuilabs.co.nz\/central\/wellington\/for-referrers\/microbiology\/how-do-i-diagnose\/tuberculosis\/\">TB culture<\/a><\/strong><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<ul>\n<li>For adult patients with severe pneumonia <strong>requiring ICU admission<\/strong>, add these tests:\n<ul>\n<li>Sputum (or other deep respiratory sample) for <strong>Gram stain and culture<\/strong><\/li>\n\n\n\n<li>Sputum (or other deep respiratory sample) for <strong><a href=\"https:\/\/www.awanuilabs.co.nz\/central\/wellington\/for-referrers\/microbiology\/how-do-i-diagnose\/legionella\/\">Legionella PCR<\/a><\/strong><\/li>\n\n\n\n<li><a href=\"https:\/\/scg.labapps.nz\/#\/WEL\/details\/27316\">Urine pneumococcal antigen<\/a><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<p><a id=\"_msocom_1\"><\/a><\/p>\n<\/div><\/details><\/div>\n\n\n\n<div class=\"wp-block-atomic-blocks-ab-accordion ab-block-accordion\"><details><summary class=\"ab-accordion-title\"><strong>Tests to avoid\/specialist tests:<\/strong><\/summary><div class=\"ab-accordion-text\">\n<ul>\n<li><strong>Urinary pneumococcal antigen testing:<\/strong>\n<ul>\n<li>We do not recommend this as a routine in those not being admitted to ICU, as all empiric antibiotic regimens for CAP are targeted at <em>S. pneumoniae<\/em> anyway, and antigen testing does not provide a susceptibility result to allow antibiotic adjustment.<\/li>\n\n\n\n<li>Although it may be used as an antimicrobial stewardship tool to narrow the antibiotic spectrum away from other organisms, evidence suggests this actually occurs infrequently in clinical practise.<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><strong>Urinary Legionella antigen testing:<\/strong>\n<ul>\n<li>This only detects <em>Legionella pneumophila<\/em> serotype 1, not <em>L. longbeachae<\/em>, which is the commonest species in NZ, so is not recommended.<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><strong>Sputum Gram stain and culture:<\/strong>\n<ul>\n<li>Not recommended for the majority of patients with CAP (other than indications above), as is heavily contaminated by upper respiratory tract organisms, and can be misleading as to the causative organism.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/div><\/details><\/div>\n\n\n\n<p><a id=\"_msocom_1\"><\/a><\/p>\n","protected":false},"excerpt":{"rendered":"Infection: community-acquired pneumonia (CAP) &#8211; Also refer to: Sputum culture test information","protected":false},"author":18,"featured_media":0,"parent":4222,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"page-left-sidebar.php","meta":{"footnotes":""},"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v24.2 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Community-acquired pneumonia (CAP) &#8211; Awanui Labs - Wellington<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.awanuilabs.co.nz\/central\/wellington\/for-referrers\/microbiology\/how-do-i-diagnose\/community-acquired-pneumonia-cap\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Community-acquired pneumonia (CAP) &#8211; Awanui Labs - Wellington\" \/>\n<meta property=\"og:description\" content=\"Infection: community-acquired pneumonia (CAP) &#8211; 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