CAP: acute infection of pulmonary parenchyma in pt who has acquired infection in community HCAP: pts w/pneumonia at any time

in their hospital stay who have had a hx of recent hospitalization in past 90 days Clinical features: cough, fever, pleuritic chest pain, dyspnea, sputum production (mucopurulent bacterial pneumonia; scant or watery atypical), GI sx (N/V/D), mental status changes Labs: leukocytosis (15-30,000) w/leftward shift PE: febrile, RR > 24, tachycardia, rales or consolidation CXR: presence of infiltrate is gold standard; can see lobar consolidation, interstitial infiltrates, cavitation Outpatient: testing for microbial dx is not done b/c empiric tx is almost always successful Hospitalized: most tx empirically w/no etiologic dx Indications for testing in hospitalized pts (blood culture, sputum culture, Legionella urinary Ag, pneumococcal urinary Ag): in ICU, failed outpatient abx therapy, cavitary infiltrates, leukopenia, active alcohol abuse, chronic severe liver disease, severe obstructive/structural lung disease, asplenia, recent travel, pleural effusion, + Legionella or pneumococcal urinary Ag Typical pneumonia: S. pneumo, H. flue, S. aureus, GAS, M. catarrhalis, anaerobes, aerobic gram negatives (Klebsiella, E. coli, Enterobacter, Serratia, Proteus, Pseudomonas, Acinetobacter) Atypical pneumonia: Legionella, M. pneumo, C. pneumo, C. psittaci Viruses: influenza, parainfluenza, RSV, adenovirus Fungi: Histoplasma, Cryptococcus, Coccidioides, Aspergillus, Pneumocystis