A 2007 prospective observational analysis of community-acquired and health care associated pneumonia in Spain provides a different perspective.11 Pneumonia etiology was similar for the 2 cohorts, with S. pneumoniae the leading pathogen in both groups (Figure 2). Inappropriate antimicrobial therapy and 30-day mortality were more common in the health care-associated pneumonia group (5.6% vs 2% [P .03]; 10.3% vs 4.3% [P .007]); however, these results do not reflect the increased prevalence of resistant pathogens like some US health care-associated pneumonia research.9,10 Inappropriate antimicrobial therapy is defined, here and after, as an antimicrobial regimen without in vitro susceptibility toward isolated pathogens. Notably, this is the first health care-associated pneumonia cohort that included both culture-positive and culture-negative pneumonia patients.