Diagnosis and features of hospital-acquired pneumonia: a retrospective cohort study

Abstract

In ward-level hospital practice 'HAP' is an over-used diagnosis that may be inaccurate in 35% of cases when objective radiological criteria are applied. Radiologically confirmed HAP represents a distinct clinical and microbiological phenotype. Potential risk factors were identified that could represent targets for preventive interventions.

The Diagnostic Yield of Noninvasive Microbiologic Sputum Sampling in a Cohort of Patients with Clinically Diagnosed Hospital‐Acquired Pneumonia

“…As such, our findings reflect the yield of sputum culture among patients with HAP for whom cultures were successfully obtained. It is not clear why only 29.4% of HAP patients received IDSA guideline-concordant care, but similar rates of culture use are reported elsewhere [13]. While physician decision-making could have contributed to this finding, it is also possible that many sick, hospitalized patients are simply unable to produce sputum for analysis.…”

“…One small single-center study demonstrated positive sputum cultures in 17/35 (48.6%) patients with radiographically confirmed cases of HAP [8], while another demonstrated positive sputum cultures in 57/63 (90.5%) [9]. We aimed to identify the frequency with which sputum cultures positively identify an organism, identify predictors of positive sputum cultures, and characterize the microbiology of sputum cultures in a large cohort of HAP cases.…”

Hospital-Acquired Pneumonia in Nonventilated Patients: The Next Frontier

“…Case series suggest that both overdiagnosis and underdiagnosis are common. 6,7 Sources of false positives include pulmonary edema, sterile aspiration pneumonitis, pulmonary embolism, lobar collapse, obstructive lung disease exacerbations, vasculitis, cryptogenic organizing pneumonia, sarcoidosis, lung cancer, and others. In addition, the diagnosis of pneumonia itself can encompass a wide range of disease severities.…”

Emerging strategies for the noninvasive diagnosis of nosocomial pneumonia

“…fever, leukocytosis, worsening oxygenation, or purulent tracheal secretions) [6]. This approach has high sensitivity but low specificity for diagnosing VAP, and a normal chest radiograph may not be completely excluding pneumonia [17]. Although chest radiography is widely used despite this limitation, computed tomography (CT) remains the gold standard.…”