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PEARLS

• The finding of bullous myringitis, which occurs in 5% of patients with M. pneumoniae infection, is approximately equal to serologic testing in its specificity for the diagnosis of this infection.
• Patients with recurrent episodes of CAP should be evaluated for aspiration, anatomic abnormality (such as bronchial obstruction/cancer), and immune deficiency (e.g., common variable immunodeficiency, HIV infection, nephrotic syndrome, multiple myeloma).
• Daptomycin should not be used to treat pneumonia; trials have shown inferior outcomes.
• CAP due to Legionella spp. or to P. aeruginosa (or other aerobic gram-negative bacilli) warrants a longer course of therapy (~21 days) than CAP of other etiologies.
• Consider C. immitis and H. capsulatum as causes of CAP in patients who have traveled to endemic areas (the southwestern U.S. and the Ohio/St. Lawrence River valleys, respectively).
• Consider melioidosis, tuberculosis, and viral infections (SARS, avian influenza) if the patient has spent time in Southeast Asia.
• Review patients’ prior microbiologic isolates to gauge their likelihood of harboring resistant organisms.
  

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