Health Care-Associated Pneumonia

Abstract

Traditionally, pneumonia developing in patients who receive health care services in the outpatient environment, such as nursing homes, long-term care facilities, and dialysis centers, has been classified and treated as community-acquired pneumonia (CAP). Recent studies, however, have shown that this type of infection, known as health care-associated pneumonia (HCAP) is distinct from CAP in terms of its epidemiology and etiology, and increases the risk for infection with multidrug-resistant (MDR) pathogens. A review of available clinical data about HCAP was conducted to determine effective empiric treatment strategies and improve clinical outcomes. Analysis of multi-institutional clinical data showed that mortality associated with HCAP is higher than with CAP, suggesting that patients with HCAP may have been treated as hospitalized patients with CAP and received inappropriate initial empiric antibiotic treatment. All patients presenting to the hospital with suspected HCAP or CAP should be evaluated for their underlying risk of infection with MDR pathogens. Because HCAP may be similar to hospital-acquired pneumonia (HAP) both clinically and etiologically, it should be treated as HAP until culture data become available. A greater recognition of HCAP as a new class of pneumonia with a distinct epidemiologic, microbiologic, and clinical profile should lead physicians to initiate appropriate empiric antibiotic therapy more often, thereby improving the likelihood for optimal clinical outcomes and patient care.

Healthcare-associated pneumonia: Diagnostic criteria and distinction from community-acquired pneumonia

“…The body of evidence presented in this review provides support for the definition of HCAP, which represents a category of pneumonia epidemiologically and microbiologically distinct from CAP. 68 Physicians should correctly identify patients with HCAP in order to provide optimal clinical management. As recommended by the ATS/IDSA nosocomial pneumonia guidelines, an empirical broad-spectrum antibiotic regimen is suggested in most patients with serious HCAP infection, especially those individuals requiring intensive care and mechanical ventilation.…”

Vitamin D's potential to reduce the risk of hospital-acquired infections

“…HCAP should be dealt with as if it is hospital-acquired pneumonia (HAP) and should be treated as such until final cultures are available. Analysis of multi-institutional clinical data showed that mortality associated with HCAP is higher than that with community-acquired pneumonia 64 . Postoperative HAP is a major risk associated with surgery.…”

Epidemiology of healthcare-associated infections among patients from a hemodialysis unit in southeastern Brazil

“…Recent studies have indicated hemodialysis units as sources of healthcare-associated pneumonia. 14 , 15 Kawasaki et al found that hemodialysis-associated pneumonia (HDAP) differed from cases arising in the community in both etiology (with predominance of Staphylococcus aureus ) and severity (with high case-fatality ratio). 16 The rate of HDAP in our study (1.35 per 1000 patients-day) was similar to that reported for nosocomial pneumonia among adult patients not submitted to mechanical ventilation in a Brazilian hospital (which was 1.02 per 1000 patients-day).…”