Follow-up care for immunocompetent adults hospitalized with suspected community-acquired pneumonia

CAP: community-acquired pneumonia; COPD: chronic obstructive pulmonary disease; EVALI: e-cigarette or vaping use-associated lung injury; SARS-CoV-2: severe acute respiratory syndrome coronavirus 2.

* If a microbiologic diagnosis has been made, the empiric regimen can be tailored to target the pathogen. In general, we continue intravenous antibiotic treatment until there is a clinical improvement.

¶ If an alternate diagnosis seems more likely, antibiotic discontinuation can be considered.

Δ Antibiotics should be broadened when worsening infection is among the suspected causes of deterioration. Antibiotic selection will vary based on patient risk factors, local epidemiology, suspected pathogens, and the initially selected regimen. Generally, regimens that include treatment for methicillin-resistant Staphylococcus aureus and Pseudomonas, in addition to routine CAP pathogens (eg, Streptococcus pneumoniae, Enterobactericae, atypcal organisms) should be selected.

◊ Evaluation varies based upon clinical picture but typically includes blood cultures, repeat sputum Gram stain and culture, or bronchoalveolar lavage, urine pneumococcal antigen testing, testing for Legionella, respiratory viruses including influenza and SARS-CoV-2, and chest computed tomography scan. Noninfectious causes of clinical deterioration should also be considered (eg, acute myocardial infarction, cardiac arrhythmias).

§ For all patients, we treat until the patient has been afebrile and clinically stable for at least 48 hours and for a minimum of five days. Patients with severe infection, chronic comorbidities, or immunocompromise may require longer courses.