Recommendations from others
The Infectious Disease Society of America (IDSA) and the Canadian Infectious Disease Society/Canadian Thoracic Society (CIDS/CTS) recommend routine sputum analysis for all inpa-tients with CAP or NHAP,8,9 while the American Thoracic Society (ATS)10 recommends performing sputum analysis only if a drug-resistant pathogen or an organism not covered by usual empiric therapy is suspected. For those with CAP or NHAP treated as outpatients, the ATS, the IDSA, and the CIDS/CTS recommend microbiological testing only if drug-resistant bacteria or an organism not covered by usual empiric therapy is suspected.
Clinical commentary
In the outpatient setting, a search for the cause is not likely to be helpful
Jon Neher, MD
Valley Medical Center, Renton, Wash
We are fortunate to have excellent guidelines for the empiric treatment of pneumonia because it is difficult to identify the causative organism. There remain, however, theoretical benefits to uncovering the cause: identification of rare organisms, selection of narrower spectrum antibiotics (lessening the community burden of antibiotic resistance), and better targeting of medications should empiric therapy prove ineffective. In the outpatient setting, a search for the cause is not likely to be helpful. In the inpatient setting—particularly in situations where empiric therapy is failing—desper-ation is a powerful motivator and still prompts use of all options available.