On 2014 Mar 09, David Keller commented:

In this case of a 67-year-old woman nursing home resident with fever, tachypnea, confusion, uremia and bilateral pneumonia, I question the decision not to obtain blood cultures, and to treat blindly with empiric therapy for community-acquired pneumonia: ceftriaxone and azithromycin. Some of her close contacts among the staff and residents of her nursing home are likely to be colonized with Pseudomonas and other resistant gram negatives. In this nursing home patient severely ill with bilateral pneumonia being considered for ICU admission, I would start with broad coverage of resistant pathogens, obtain blood cultures, and narrow the therapeutic spectrum as soon as warranted by the patient’s clinical status and culture results. I agree with the need to limit the use of broad-spectrum antibiotics, but it seems like too much of a gamble to leave gaps in her coverage, without drawing cultures, when she is this ill.

1: Wunderink RG, Waterer GW. Clinical practice. Community-acquired pneumonia. N Engl J Med. 2014 Feb 6;370(6):543-51. doi: 10.1056/NEJMcp1214869. PubMed PMID: 24499212.

On 2014 Mar 09, David Keller commented:

In this case of a 67-year-old woman nursing home resident with fever, tachypnea, confusion, uremia and bilateral pneumonia, I question the decision not to obtain blood cultures, and to treat blindly with empiric therapy for community-acquired pneumonia: ceftriaxone and azithromycin. Some of her close contacts among the staff and residents of her nursing home are likely to be colonized with Pseudomonas and other resistant gram negatives. In this nursing home patient severely ill with bilateral pneumonia being considered for ICU admission, I would start with broad coverage of resistant pathogens, obtain blood cultures, and narrow the therapeutic spectrum as soon as warranted by the patient’s clinical status and culture results. I agree with the need to limit the use of broad-spectrum antibiotics, but it seems like too much of a gamble to leave gaps in her coverage, without drawing cultures, when she is this ill.

1: Wunderink RG, Waterer GW. Clinical practice. Community-acquired pneumonia. N Engl J Med. 2014 Feb 6;370(6):543-51. doi: 10.1056/NEJMcp1214869. PubMed PMID: 24499212.