S. pneumoniae and H. influenzae are frequent causes, and in those with septic emboli or endocarditis, S. aureus should be considered. Aspiration may result in infection with S. pneumoniae, polymicrobial oral flora, S. aureus, or Pseudomonas spp. P. carinii, cytomegalovirus, or atypical mycobacteria should be considered in HIV-positive patients. Drug-resistant tuberculosis also should be strongly considered. IVDU patients are also more likely to have extrapulmonary tuberculosis, including infection in cervical lymph nodes, CNS, bone, abdomen, genitourinary system, pericardium, skin, and the eyes. 28
Because of the risk of atypical infection, coincident bacteremia, and endocarditis, admission to the hospital is recommended in all patients with pneumonia or other pulmonary infection. Patients should be placed on respiratory isolation until tuberculosis has been excluded.
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