A 35-year-old male who was recently hospitalized for abdominal surgery presents with a new fever, productive cough, and dyspnea. On physical examination, there are decreased breath sounds on the left side of the chest. What is your working diagnosis and next steps?
This patient's recent hospitalization and abdominal surgery, along with his symptoms, raise the suspicion of hospital-acquired (nosocomial) pneumonia. This type of pneumonia often involves different pathogens than community-acquired pneumonia, with a higher likelihood of resistant organisms. The next steps would include chest imaging to confirm the presence of pneumonia and blood and sputum cultures to identify the causative organism. Empiric antibiotic therapy should be initiated promptly, often with a broad-spectrum antibiotic that covers both Gram-positive and Gram-negative organisms, including MRSA and Pseudomonas.