Inflammatory Marker Tests

Bacterial etiologies have been associated with higher

serum procalcitonin concentrations, but a cutoff level to distinguish viral
from bacterial illness has not been established. Therefore, the IDSA and
ATS do not recommend use of procalcitonin levels to determine whether
to initiate antibiotic treatment. In addition, serial procalcitonin
concentrations are not generally recommended to determine treatment
duration; procalcitonin levels may not be increased in patients with
bacterial/viral coinfection or in cases of pneumonia caused
by Legionella or Mycoplasma spp.

Polymerase Chain Reaction Tests

A rapid influenza PCR is recommended in adult patients with CAP during
seasons of increased influenza activity but is not essential when few
influenza cases are being reported. Tests for influenza and other
respiratory viruses are recommended in pediatric patients with CAP. Refer
to the ARUP Consult Influenza topic for guidance about recommended
testing.

Nasal Swab for MRSA

Nasal PCR offers high specificity and negative predictive value (NPV) for
MRSA pneumonia. In the absence of nasal colonization, MRSA pneumonia
is unlikely. Coverage for MRSA pneumonia can often be suspended when
the results of nasal swab testing are negative, particularly when CAP is
not severe. Nasal culture for MRSA is associated with the same high
specificity and NPV and may be less costly than PCR, but PCR yields
results more rapidly.