Healthcare-associated pneumonia: meeting the yeti

Clinical characteristics and outcome of healthcare associated pneumonia in Turkey

“…The concept of HCAP originated from US studies that reported that certain risk factors, which were ultimately included in the definition, were associated with infection due to resistant bacteria and with worse clinical outcomes (15)(16)(17). However, this definition has recently been challenged with several studies from Europe and Japan (18)(19)(20)(21)(22) and criticized because it led to excessive use of antibiotics, with consequent increases in costs and resistance rates (23)(24)(25). Those studies showed that, using the American Thoracic Society definition, etiological agents were similar in CAP and HCAP and defined different risk factors for drug-resistant pneumonia.…”

Drug-resistant pathogens in community-acquired pneumonia

“…Shindo et al stated that HCAP patients had more severe diseases, higher initial inappropriate antimicrobial treatment, and higher mortality when compared to CAP patients. [7] Despite having more severe diseases, the rate of mechanical ventilation was similar in both groups, which leads to the idea that treatment restrictions could explain mortality differences between both the groups as suggested by Ewig et al [27] Contrary to previous data, several European studies addressed similarities in the etiological pattern between HCAP and CAP, with S. pneumoniae being the main causative microorganism and with a very low incidence of DRPs in both entities. [28][29][30][31] In addition, García-Vidal et al showed that aspiration pneumonia was more frequent in HCAP patients, suggesting the same treatment for both CAP and HCAP patients after ruling out the presence of aspiration pneumonia.…”