eMedicine Specialties > Pediatrics: General Medicine > Infectious Disease
Hospital-Acquired Infections: Differential Diagnoses & Workup
Updated: Jan 14, 2009
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
Differential Diagnoses
Other Problems to Be Considered
Rotavirus infection
Sepsis
Streptococcal infection, group D (enterococcus)
Workup
Laboratory Studies
A detailed physical examination and review of systems most likely reveal the involved organs or systems. Investigation should focus on these abnormal areas. Studies should center on infections in the bloodstream, UTI, and pneumonia, unless an obvious source (eg, surgical-site infection) is readily identified.
- Bloodstream infections
- Obtaining quantitative blood cultures with samples from the intravenous line and peripheral vein is recommended to aid in differential diagnosis of line-associated bacteremia. Because of the small volume of blood that is vacuum aspirated into quantitative sample tubes, a regular blood culture is recommended, as this sample may grow the pathogen in cases involving low-inoculum bacteremia.
- Fungal cultures should be obtained if fungal infection is suspected. The laboratory should incubate cultures longer for fungus detection than for other pathogens.
- In immunocompromised patients, special studies are occasionally requested, such as cultures for nocardia and atypical mycobacteria, cytomegalovirus, and cytomegalovirus antigenemia detection.
- Pneumonia
- Radiography, oxygenation, and hemodynamic status determination are required in the evaluation of nosocomial pneumonia.
- Examination of the sputum, endotracheal aspiration material, and pleural effusion fluid with Gram staining and culturing may be useful.
- Rapid diagnostic testing may be useful in specific cases. Examples include the direct fluorescent antibody test for Legionella organisms or for organisms that cause pertussis; immunofluorescence tests for influenza, respiratory syncytial virus, which is transmitted by contact, and Pneumocystis jiroveci; and modified acid-fast stains for mycobacteria.
- Urinary tract infection
- UTIs are expected in patients who require indwelling urinary catheters.
- Efforts should be made to differentiate colonization, cystitis, and frank pyelonephritis using urinalysis, urine Gram staining, and culturing.
- Early removal of the urinary catheter is always helpful in the treatment of catheter-associated UTI.
- Colitis
- A stool Gram stain should be performed to detect WBCs.
- Tests for C difficile toxins are useful in the workup for nosocomial fevers and loose stool. (Rotavirus spreads among susceptible infants during local epidemics in cold months. In infants, colonization with C difficile often does not cause problems.)
- Other laboratory studies
- Obtaining general viral cultures from the throat and rectum can be helpful in management.
- Acute and convalescent titers against viral agents can also be helpful.
- The antigen for Legionella pneumophila serotype 1 can be detected in the urine.
- Several versions of the nucleic acid amplification test (NAAT) are available to test for specific pathogens in most clinical samples. NAATs have been developed for a wide variety of infectious pathogens and permit rapid diagnoses.
Imaging Studies
- Special imaging techniques (eg, ultrasonography, CT scanning, MRI) may be helpful in evaluating obscure-site infections.
More on Hospital-Acquired Infections |
| Overview: Hospital-Acquired Infections |
 Differential Diagnoses & Workup: Hospital-Acquired Infections |
| Treatment & Medication: Hospital-Acquired Infections |
| Follow-up: Hospital-Acquired Infections |
| References |
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References
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Further Reading
Keywords
hospital-acquired infections, health care–acquired infections, nosocomial infection, vancomycin-resistant enterococcus, VRE, methicillin-resistant Staphylococcus aureus, MRSA, Pseudomonas, candidiasis, Legionella, respiratory syncytial virus, thrush, Clostridium difficile, viral respiratory infections, influenza, parainfluenza, sinusitis, otitis, tracheitis, phlebitis, line infection, bloodstream infection, ventilator-associated pneumonia, urinary tract infection, UTI, surgical-site infection, coagulase-negative staphylococci, enterococci, fungi, , pseudomonads,
