Answer to the last #DiagnosticDilemma
Answer: C. Healthcare-Associated Pneumonia

This patient likely has healthcare-associated pneumonia (HCAP) based on his daily visits to a dialysis center. Broadly speaking, the diagnosis of HCAP extends to anyone that meets the following criteria:

• Hospitalization in the past 90 days

• Residence in a nursing home or long-term care facility

• Receiving outpatient infusion therapy (eg, antibiotics, chemotherapy) in the past 30 days

• Attending a dialysis center in the past 30 days

The importance of establishing the category of the pneumonia is that it suggests the most likely pathogens and guides treatment choices.

Along with hospital-associated pneumonia (HAP) and ventilator-associated pneumonia (VAP), patients with HCAP require antibiotic coverage for multidrug-resistant pathogens such as Pseudomonas aeruginosa, Acinetobacter baumannii, antibiotic-resistant enteric gram-negative bacilli (eg, Escherichia coli), and methicillin-resistant Staphylococcus aureus.

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