Division 4.1.10 PN: Pneumonia

Two or more serial chest X-rays or CT-scans with a suggestive image of pneumonia for patients with underlying cardiac or pulmonary disease. In patients without underlying cardiac or pulmonary disease one definitive chest X-ray or CT-scan is sufficient

AND at least one of the following symptoms

• Fever > 38 °C with no other cause

• Leukopenia (< 4 000 WBC/mm³) or leucocytosis (≥ 12 000 WBC/mm³)

AND at least one of the following (or at least two if clinical pneumonia only = PN 4 and PN 5)

• New onset of purulent sputum, or change in character of sputum (colour, odour, quantity, consistency)

• Cough or dyspnea or tachypnea

• Suggestive auscultation (rales or bronchial breath sounds), ronchi, wheezing

• Worsening gas exchange (for example, O₂ desaturation or increased oxygen requirements or increased ventilation demand)

and according to the used diagnostic method

1. (a)

   Bacteriologic diagnostic performed by:

   Positive quantitative culture from minimally contaminated LRT^f1 specimen (PN 1)

   • Broncho-alveolar lavage (BAL) with a threshold of ≥ 10⁴ CFU^f2/ml or ≥ 5 % of BAL obtained cells contains intracellular bacteria on direct microscopic exam (classified on the diagnostic category BAL)

   • Protected brush (PB Wimberley) with a threshold of ≥ 10³ CFU/ml

   • Distal protected aspirate (DPA) with a threshold of ≥ 10³ CFU/ml

   Positive quantitative culture from possibly contaminated LRT specimen (PN 2)

   • Quantitative culture of LRT specimen (for example, endotracheal aspirate) with a threshold of 10⁶ CFU/ml

2. (b)

   Alternative microbiology methods (PN 3)

   • Positive blood culture not related to another source of infection

   • Positive growth in culture of pleural fluid

   • Pleural or pulmonary abscess with positive needle aspiration

   • Histologic pulmonary exam shows evidence of pneumonia

   • Positive exams for pneumonia with virus or particular germs (for example, Legionella, Aspergillus, mycobacteria, mycoplasma, Pneumocystis jirovecii):

     • Positive detection of viral antigen or antibody from respiratory secretions (for example, EIA, FAMA, shell vial assay, PCR)

     • Positive direct exam or positive culture from bronchial secretions or tissue

     • Seroconversion (for example, influenza viruses, Legionella, Chlamydia)

     • Detection of antigens in urine (Legionella)

3. (c)

   Others

   • Positive sputum culture or non-quantitative LRT specimen culture (PN 4)

   • No positive microbiology (PN 5)