Present on admission

I have patient that was admitted with aspiration pneumonia with secondary bacterial pneumonia sputum culture  MRSA.  Attending and consultants documentation both in agreement on diagnosis.  Subsequent sputum cultures completed 4 days into stay which returned as MRSA.   Sputum culture repeated again on the 10th hospital day  with findings of pseudomonas.  I am having hard time with POA on this one since patient was admitted with pneumonia but pseudomonas was not on cultures until 10 days into stay.  I am thinking has to be no on POA,  uncertain on querying for present on admission status.   If someone could please give thoughts.


  • This could very well be a case of PNA with multiple organisms. Just because the Pseudomonas did not show up on the day 4 culture, doesn't mean it couldn't have been present on admission. I am not sure about the querying practice (fully electronic/ verbal/ combination) at your facility. I would suggest a discussion between the CDI and MD about the overall picture - focusing the conversation on the potential possibility of a multi-etiology PNA. This seems far from a straightforward scenario, therefore a discussion with the MD (with the query) for POA status of Pseudomonas could be more effective than sending a cold electronic query. There is no perfect way to 100% fix this overall picture. I am suggesting what I would potentially try. Hope this helps. 
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