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Abstract
Pneumonia is frequently encountered in the clinical fields, both as a cause for admission and as a complication of the underlying disorder or as the course of treatment. Pneumonia is the second most common hospital-acquired infection and is associated with the highest morbidity and mortality rates among hospital-acquired infections. The guidelines for the management of hospital-acquired pneumonia by the American Thoracic Society include identifying individuals who have recently received antibiotics therapy or have been in medical facilities; these individuals are at higher risk for infection with multiple drug resistant organisms. Individuals, who have acquired pneumonia according to this clinical scenario, have what is known as healthcare-associated pneumonia (HCAP). Patients with HCAP should be considered to have potentially drug-resistant pathogens and should receive broad spectrum empiric antibiotic therapy directed at the potentially resistant organisms. In this paper, the diagnosis, risk factors, and treatment of HCAP are discussed.
Figures and Tables
Figure 1
Algorithm for the current management recommendations for HCAP. HCAP: healthcare-associated pneumonia; MDR: multi drug resistant (This Figure is reprinted from the article by ATS and IDSA2 [2005, p. 388-416]).
Figure 2
Recommendations for assessing response to initial antibiotic therapy, de-escalation and stopping antibiotics in patients with suspected HCAP. HCAP: healthcare-associated pneumonia; WBC: white blood cells; CXR: chest X-ray; SaO2: oxygen saturation; Cxs: complications; Dx: diagnosis; Tx: treatment (This Figure is reprinted from the article by ATS and IDSA2 [2005, p. 388-416]).
Table 3
Clinical indications for more extensive diagnostic testing
*A: Endotracheal aspirate if intubated, possibly bronchoscopy or nonbronchoscopic bronchoalveolar lavage; B: Fungal and tuberculosis cultures; C: Thoracentesis and pleural fluid cultures. UAT: urinary antigen tests (This Table is reprinted from the article by Mandell et al.1 [2007, p. 27-72]).
Table 4
Recommendations for initial, broad-spectrum, empiric therapy for HCAP with no risk factors for MDR pathogens
This Table is reprinted from the article by ATS and IDSA2 [2005, p. 388-416].
Table 5
Recommendations for initial, broad-spectrum, empiric therapy for HCAP with risk factors for MDR pathogens
HACP: healthcare-associated pneumonia; MDR: multi drug resistant; MRSA: Methicillin-resistant Staphylococcus aureus (This Table is reprinted from the article by ATS and IDSA2 [2005, p. 388-416]).
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