TY - JOUR T1 - The Challenging Diagnosis of Non-Community-Acquired Pneumonia in Non-Mechanically Ventilated Subjects: Value of Microbiological Investigation JF - Respiratory Care DO - 10.4187/respcare.04143 SP - respcare.04143 AU - Jonathan Messika AU - Annabelle Stoclin AU - Eric Bouvard AU - Jean-Pierre Fulgencio AU - Christophe Ridel AU - Ioan-Paul Muresan AU - Jean-Jacques Boffa AU - Claude Bachmeyer AU - Michel Denis AU - Valérie Gounant AU - Adoracion Esteso AU - Valeria Loi AU - Charlotte Verdet AU - Hélène Prigent AU - Antoine Parrot AU - Muriel Fartoukh Y1 - 2015/12/08 UR - http://rc.rcjournal.com/content/early/2015/12/08/respcare.04143.abstract N2 - BACKGROUND: Early recognition and an attempt at obtaining microbiological documentation are recommended in patients with non-community-acquired pneumonia (NCAP), whether hospital-acquired (HAP) or health care-associated (HCAP). We aimed to characterize the clinical features and microbial etiologies of NCAP to assess the impact of microbiological investigation on their management.METHODS: This was a prospective 1-y study in a university hospital with 141 non-mechanically ventilated subjects suspected of having HAP (n = 110) or HCAP (n = 31).RESULTS: Clinical criteria alone poorly identified pneumonia (misdiagnosis in 50% of cases). Microbiological confirmation was achievable in 80 subjects (57%). Among 79 microorganisms isolated, 28 were multidrug-resistant aerobic Gram-negative bacilli and group III Enterobacteriaceae and 6 were methicillin-resistant Staphylococcus aureus. Multidrug-resistant aerobic Gram-negative bacilli accounted for one third of the microorganisms in early-onset HAP and for 50% in late-onset HAP. Methicillin-resistant S. aureus was most often recovered from subjects with HCAP. Inappropriate empirical antibiotics were administered to 36% of subjects with confirmed pneumonia. Forty subjects were admitted to the ICU, 13 (33%) of whom died. Overall, 39 subjects (28%) died in the hospital.CONCLUSIONS: Integrating the microbiological investigation in the complex clinical diagnostic workup of patients suspected of having NCAP is mandatory. Respiratory tract specimens should be obtained whenever possible for appropriate management. ER -