Pneumonia is 1 of the 3 most common infections identified in nursing home residents and is associated with the highest mortality of any infection in this setting. In regard to pneumonia in the nursing home setting, practitioners are focused primarily on identifying residents with this infection and choosing a treatment regimen. In this article, the diagnosis of this infection is addressed. Based on published studies and clinical experience, "bedside criteria" for the diagnosis of nursing home-associated pneumonia (NHAP) are proposed that are based primarily on objective respiratory signs and symptoms that can be readily identified by staff. It is also stressed that factors predisposing to aspiration should be identified because there is a risk for aspiration pneumonitis. A previously published decision tool to distinguish between aspiration pneumonia and aspiration pneumonitis is discussed. Because providers are often not present when there is a change in status of a resident, nursing staff are crucial to the diagnosis of NHAP. However, there is variability in staff experience and the ability to obtain and communicate clinical findings to assist providers in making decisions about diagnosis. To deal with this issue, templates have been developed to help staff collect the appropriate information before contacting the provider. The most important diagnostic test in a resident with suspected pneumonia is a chest radiograph. However, studies done more than a decade ago demonstrated considerable variability in radiologists' interpretation of chest radiographs of residents performed in the nursing home. Radiologic techniques have improved considerably with utilization of digital technology, but there have been no recent studies to determine if interpretation of these radiographs is more consistent. An alternative to radiographs is lung ultrasonography, which has been found to be more accurate than chest radiographs in identifying pneumonia in adults; however, this method has not been studied in the nursing home setting. Host biomarkers such as serum C-reactive protein and procalcitonin levels have been studied in adults with pneumonia to distinguish between bacterial and nonbacterial infection, but there has been limited study in NHAP and the findings are conflicting. Lastly, it is stressed that the provider should carefully document the clinical findings and testing that result in a diagnosis of pneumonia to enhance surveillance for infection as well as antimicrobial stewardship activities.

中文翻译：

---

疗养院相关性肺炎，第一部分：诊断

肺炎是疗养院居民中发现的 3 种最常见感染之一，并且与该环境中任何感染的最高死亡率相关。关于疗养院环境中的肺炎，从业者主要关注识别感染这种感染的居民并选择治疗方案。在本文中，讨论了这种感染的诊断。根据已发表的研究和临床经验，提出了诊断疗养院相关性肺炎 (NHAP) 的“床边标准”，主要基于工作人员可以轻松识别的客观呼吸道体征和症状。还强调应确定易发生误吸的因素，因为存在误吸性肺炎的风险。讨论了先前发表的用于区分吸入性肺炎和吸入性肺炎的决策工具。由于当居民身份发生变化时，提供者通常不在场，因此护理人员对 NHAP 的诊断至关重要。然而，工作人员的经验以及获取和交流临床发现以帮助提供者做出诊断决策的能力存在差异。为了解决这个问题，我们开发了模板来帮助工作人员在联系提供商之前收集适当的信息。疑似肺炎患者最重要的诊断测试是胸片。然而，十多年前进行的研究表明，放射科医师对在疗养院进行的居民胸部 X 光片的解释存在相当大的差异。随着数字技术的使用，放射学技术得到了显着改善，但最近没有研究来确定对这些 X 光片的解释是否更加一致。X光片的另一种选择是肺超声检查，已发现它在识别成人肺炎方面比胸片更准确；然而，这种方法尚未在疗养院环境中进行过研究。已经在成人肺炎中研究了宿主生物标志物，如血清 C 反应蛋白和降钙素原水平，以区分细菌感染和非细菌感染，但在 NHAP 中的研究有限，研究结果相互矛盾。最后，