In the mean time, AG recommend only culture the blood in the four previously described scenarios (outbreak or recent travel to a risky geographical region). – Influenza disease. the Pneumonia Severity Index (PSI). EG and AG share a EN6 similar core of recommendations and only differ in small issues such as new antibiotics. Similarly, both recommendations recommend against the routine EN6 prescription of steroids as an adjuvant therapy. (MRSA) or will become performed, (c) when the patient has been infected with MRSA and/or (especially those with prior respiratory tract illness) or (d) in individuals who have been hospitalized and received parenteral antibiotics during the last 90 days. – Blood tradition. The EG recommend obtaining two set of blood culture in all individuals that require hospitalization. In the mean time, AG recommend only culture the blood in the four previously explained scenarios (outbreak or recent travel to a risky geographical region). – Influenza disease. Traditional quick influenza diagnostic checks have a level of sensitivity of 60% and a specificity of 98% [20]. Newer checks, based on quick nucleic acid amplification, have improved their level of sensitivity to more than 90% keeping the high specificity [21]. Both recommendations recommend detecting influenza and respiratory disease guided by epidemiological factors. – Mycoplasma pneumonia and Chlamydia pneumoniae (only described in EG). Only use these checks when a high medical suspicion of atypical agent is present and always associated with PCR techniques. – Invasive techniques (only described in EG). Thoracocentensis should be performed in hospitalized individuals with CAP when a significant pleural effusion is present. Bronchoscopic safeguarded specimen brush, bronchoalveolar lavage and quantitative endotracheal aspirate should be the desired technique in non-resolving pneumonia. Transthoracic needle aspiration can be considered only in excellent circumstances of seriously ill individuals, with focal infiltrates in whom less invasive techniques have been non-diagnostic. DETERMINE WHERE THE PATIENT SHOULD BE TREATED Determining where the patient should be treated requires answering two questions: should the patient be admitted to the hospital? and then, should the Rabbit Polyclonal to C1QB patient be considered for rigorous level of monitoring and treatment (e.g. rigorous care unit [ICU], step-down or telemetry unit)? Every physician should always be aware that delay in ICU admission is an self-employed predictor of hospital mortality and longer length of stay [22,23]. Both recommendations acknowledge that the decision to hospitalize a patient is medical. However, it should EN6 be complemented with objective tools for risk assessment. The EG recommend the CRB-65 while the AG recommend the Pneumonia Severity Index (PSI). Indeed, other factors exist in addition to medical severity that should be considered at the moment of determining the need for hospital admission (e.g. failure to maintain oral intake, severe comorbid illness, impaired functions status, etc.) [7,24,25]. The EG identified that biomarkers (e.g. CRP or PCT) have a significant potential to improve assessment of severity, but have not been sufficiently evaluated to influence the hospitalization decision. Regarding ICU admission, EG recommends admitting individuals with acute respiratory failure, sepsis or septic shock, radiographic extension of infiltrate or seriously decompensated comorbidities. The AG maintain the IDSA-2007 [26] recommendation for ICU admission but also mention that SMART-COP (a score for identifying individuals who need vasopressor support and/or mechanical air flow) [27] or SCAP (score for predicting the risk of adverse results) [28] score could be applied. ANTIMICROBIAL THERAPY In most of the instances, antimicrobial therapy should be empiric and consider providers against major micro-organisms that cause CAP as well as the individuals features (e.g. presence of specific risk factor, allergies, intolerances, etc.). Concerning the micro-organisms, several observational data suggest that in-patient and outpatients CAP are caused by the same pathogens, except for and Gram-negative bacilli which are hardly ever recorded in outpatient establishing [11]. As bacterial pathogen often coexists with viruses and EN6 currently there is not a test accurate or fast plenty of to determine the CAP is solely caused by a virus, AG recommend constantly empirically cover bacterial microorganism. Assessment against antibacterial recommendation in EG versus AG can be appreciated in table 2. In addition, it is important to focus on that recommendations recommend initiating antimicrobial therapy as early as possible, within the 1st hour if the patient is in septic shock. Table 2 Assessment between empirical antibiotic recommendation in Western and American recommendations for hospitalized individuals having a community acquired pneumonia and (MSSA and.