In contrast to the defined culture threshold for bacterial CFU, there is no such standard to distinguish fungal colonization from fungal infections. It has been questioned whether Candida pneumonia exists at all. In particular, the role of Candida species remains a diagnostic dilemma. There is still debate whether fungal infections play a role in the development of pneumonia. Bronchoalveolar lavage examination showing more than the cutoff value of 2% intracellular organisms (ICO) and BAL culture yielding more than 10 4 colony-forming units (CFU)/mL is recognized as proof of a bacterial infection. BAL is indicated if there is clinical suspicion of pneumonia, ie, a newly developed infiltrate on the chest x-ray, fever, and an increased leukocyte count in the blood. The bronchoalveolar lavage (BAL) is a widely accepted diagnostic tool to confirm the diagnosis of pneumonia and to identify the nature of the associated pathogen. If pneumonia affects a patient on the respirator it is called ventilator-associated pneumonia (VAP).
If the patient lives in a nursing home or comparable institution before admittance, the causative pathogen is more likely within the spectrum of HAP. Community-acquired pneumonia is distinguished from hospital-acquired pneumonia (HAP) because the latter develops when the patient is already admitted to hospital.
When pneumonia is developed at home it is called community-acquired pneumonia (CAP). There are known differences in the spectrum of these pathogens, depending on the circumstances at the time the patient acquired pneumonia. In the majority of cases, the pathogenic organism is of bacterial origin. Pneumonia is a frequent diagnosis in patients admitted to the intensive care unit (ICU).
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