Healthcare-associated pneumonia: Who is truly at risk for multidrug-resistant pathogens?

Abstract

I n 2005, joint guidelines issued by the American Thoracic Society (ATS) and the Infectious Diseases Society of America (IDSA) provided the first definition of healthcareassociated pneumonia (HCAP). 1 This new classification was added to the existing classes of communityacquired pneumonia (CAP) and hospital-acquired pneumonia (HAP) and represented a significant change in pneumonia management. The change was particularly important with regard to patients acquiring pneumonia in a community setting. The guidelines recognized that a changing healthcare delivery system meant that patient exposures to healthcare environments and healthcare-associated pathogens no longer occurred exclusively in acute care settings but could occur in a growing spectrum of community healthcare settings such as skilled nursing centers, long-term care facilities, infusion centers, and dialysis clinics. 2 With a growing potential for such exposures, it was recognized that patients with pneumonia traditionally diagnosed and managed as CAP may instead have healthcare-related pathogen exposures and infections requiring treatment more consistent with that provided for HAP. To help clinicians identify patients presenting with pneumonia

Management of Nosocomial Pneumonia

“…[12][13][14] Thus, the HCAP definition was eliminated from the 2016 nosocomial pneumonia guidelines. Most likely, further discussion of risk factors and the specific management of patients with HCAP will follow in the updated version of the IDSA/ATS community-acquired pneumonia guidelines, which is expected to publish in 2018.…”