MEDizzy - An 84-year-old bedridden patient in the hospital develops

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Infectious disease 1

An 84-year-old bedridden patient in the hospital develops cough, fever, and shortness of breath. On physical examination, the JVP is at 4 cm, heart sounds are normal, and there are crackles on inspiration in the right lower lobe. A CXR reveals a new right lower lobe infiltrate and his WBC is 15,000/mL. He was admitted to the hospital 7 days ago for the treatment of congestive heart failure. Which of the following is the most likely diagnosis?

ExplanationHospital-acquired pneumonia is defined as pneumonia occurring >48 hours after admission and not incubating at the time of admission. It is caused by S aureus, Gram-negative bacilli, or Streptococcus pneumoniae. Mixed aerobic and anaerobic infections are also common. Pulmonary embolism is always a consideration in the diagnosis based on clinical probability. The elevated WBC makes atelectasis unlikely and the normal JVP rules out congestive heart failure.