Absolute criteria - all 3 of the following required:
(1) a new or increasing infiltrate on chest radiograph
(2) purulent tracheobronchial secretions
(3) sputum Gram stain with many neutrophils, < 10 epithelial cells, and the predominance of one organism
Additional criteria:
(1) fever, with temperature > 100.4°F
(2) leukocytosis or leukopenia
(3) rales or dullness on percussion on chest physical examination
(4) no improvement in chest radiograph after 2-3 treatments of chest physiotherapy over a 6 hour period
where:
• The sputum appearance indicates the need for a good, deep specimen not contaminated by saliva and oral flora. Some institutions use respiratory therapists to obtain a proper specimen.
• The reference range for the normal leukocyte count in the peripheral blood varies by age and can be affected by race. I used 4,000 to 11,000 per µL in the implementation.
• The criteria are based on the criteria for nosocomial pneumonia from the Centers for Disease Control and Prevention (CDC).
