 2. Medical record notation of 1 respiratory symptom cough, sputum production, dyspnea, tachypnea, or pleuritic pain, and 1 auscultation finding rales or crepitations, and 1 sign of infection temperature 38C, shivering, or white blood cell count 10,000μL or 4,000μL, and a new infiltrate on chest radiography or CT-scan performed within 48 hours of admission. 