Abstract：
The purpose of this article is to review diagnostic testing recommendations outlined in the current American Thoracic Society (ATS)/Infectious Diseases Society of America (IDSA) community-acquired pneumonia (CAP) guideline and the 2021 ATS guideline for noninfluenza respiratory viruses.
Diagnostic testing in CAP with gram stain, lower respiratory and blood cultures, Streptococcal and Legionella urinary antigens are not routinely recommended unless identified as severe CAP or with risk factors for Methicillin-resistant Staphylococcus aureus (MRSA) or Pseudomonas aeruginosa infection. Influenza virus testing remains a strong recommendation during periods of community viral spread.An additional 2021 ATS clinical practice guideline reviewed the use of molecular testing for noninfluenza viral pathogens in adults with suspected CAP and recommended testing in those hospitalized with severe CAP and/or various immunocompromising conditions.
Diagnostic testing remains an important component of confirming and treating CAP. The CAP guideline includes recommendations surrounding diagnostic testing with lower respiratory gram stain and culture, blood cultures, Legionella and Pneumococcal urinary antigen, influenza viral testing and serum procalcitonin.There is a strong recommendation to obtain influenza virus testing during periods of community spread. However, the use of other diagnostics such as gram stain, lower respiratory and blood culture, and urinary antigen testing are dependent on severity of illness and whether a patient has been identified as having strong risk factors for MRSA or P. aeruginosa infection. The 2021 ATS clinical practice document did not routinely recommend testing noninfluenza respiratory viruses unless identified as having severe CAP and/or various immunocompromising conditions.
Diagnostic testing in CAP with gram stain, lower respiratory and blood cultures, Streptococcal and Legionella urinary antigens are not routinely recommended unless identified as severe CAP or with risk factors for Methicillin-resistant Staphylococcus aureus (MRSA) or Pseudomonas aeruginosa infection. Influenza virus testing remains a strong recommendation during periods of community viral spread.An additional 2021 ATS clinical practice guideline reviewed the use of molecular testing for noninfluenza viral pathogens in adults with suspected CAP and recommended testing in those hospitalized with severe CAP and/or various immunocompromising conditions.
Diagnostic testing remains an important component of confirming and treating CAP. The CAP guideline includes recommendations surrounding diagnostic testing with lower respiratory gram stain and culture, blood cultures, Legionella and Pneumococcal urinary antigen, influenza viral testing and serum procalcitonin.There is a strong recommendation to obtain influenza virus testing during periods of community spread. However, the use of other diagnostics such as gram stain, lower respiratory and blood culture, and urinary antigen testing are dependent on severity of illness and whether a patient has been identified as having strong risk factors for MRSA or P. aeruginosa infection. The 2021 ATS clinical practice document did not routinely recommend testing noninfluenza respiratory viruses unless identified as having severe CAP and/or various immunocompromising conditions.
摘要：
本文的目的是回顾当前美国胸科学会（ATS）/美国传染病学会（IDSA）社区获得性肺炎（CAP）指南和2021ATS非流感呼吸道病毒指南中概述的诊断测试建议。
CAP中革兰氏染色的诊断测试，下呼吸道和血液培养，除非确定为严重CAP或具有耐甲氧西林金黄色葡萄球菌（MRSA）或铜绿假单胞菌感染的危险因素，否则不建议常规使用链球菌和军团菌尿抗原。在社区病毒传播期间，流感病毒检测仍然是一个强烈推荐。另一项2021年ATS临床实践指南回顾了在疑似CAP的成年人中使用非流感病毒病原体进行分子检测，并建议在患有严重CAP和/或各种免疫受损疾病的住院患者中进行检测。
诊断测试仍然是确认和治疗CAP的重要组成部分。CAP指南包括有关下呼吸道革兰氏染色和培养的诊断测试的建议，血培养,军团菌和肺炎球菌尿抗原，流感病毒检测和血清降钙素原。强烈建议在社区传播期间进行流感病毒检测。然而,使用其他诊断方法，如革兰氏染色，下呼吸道和血液培养，和尿抗原检测取决于疾病的严重程度以及是否已确定患者具有MRSA或铜绿假单胞菌感染的强危险因素。2021年ATS临床实践文件不建议常规测试非流感呼吸道病毒，除非确定具有严重的CAP和/或各种免疫受损条件。
CAP中革兰氏染色的诊断测试，下呼吸道和血液培养，除非确定为严重CAP或具有耐甲氧西林金黄色葡萄球菌（MRSA）或铜绿假单胞菌感染的危险因素，否则不建议常规使用链球菌和军团菌尿抗原。在社区病毒传播期间，流感病毒检测仍然是一个强烈推荐。另一项2021年ATS临床实践指南回顾了在疑似CAP的成年人中使用非流感病毒病原体进行分子检测，并建议在患有严重CAP和/或各种免疫受损疾病的住院患者中进行检测。
诊断测试仍然是确认和治疗CAP的重要组成部分。CAP指南包括有关下呼吸道革兰氏染色和培养的诊断测试的建议，血培养,军团菌和肺炎球菌尿抗原，流感病毒检测和血清降钙素原。强烈建议在社区传播期间进行流感病毒检测。然而,使用其他诊断方法，如革兰氏染色，下呼吸道和血液培养，和尿抗原检测取决于疾病的严重程度以及是否已确定患者具有MRSA或铜绿假单胞菌感染的强危险因素。2021年ATS临床实践文件不建议常规测试非流感呼吸道病毒，除非确定具有严重的CAP和/或各种免疫受损条件。
