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What is healthcare-associated pneumonia and how is it managed?
Curr Opin Infect Dis. 2008 Apr;21(2):168-73
Authors: Carratalà J, Garcia-Vidal C
PURPOSE OF REVIEW: Pneumonia developing before hospital admission in patients in close contact with the health system was recently termed 'healthcare-associated pneumonia' and proposed as a new category of respiratory infection. We focus on the recent literature concerning the epidemiology, causative organisms, antibiotic susceptibilities, and outcomes of and empirical antibiotic therapy for this condition. RECENT FINDINGS: The reported incidence of healthcare-associated pneumonia among patients requiring hospitalization for pneumonia ranges from 17% to 67%. Hospitalization within 90 days before pneumonia, attending a dialysis clinic and residing in a nursing home were the most common criteria for healthcare-associated pneumonia. Compared with patients with community-acquired pneumonia, those with healthcare-associated pneumonia are older, have greater co-morbidity, and are more likely to have aspiration pneumonia and pneumonia caused by antibiotic-resistant pathogens. Patients with healthcare-associated pneumonia also more frequently initially receive an inappropriate antibiotic therapy, have higher case fatality rates and have longer hospital stay. SUMMARY: Many patients hospitalized with pneumonia via the emergency department have healthcare-associated pneumonia. There are significant differences in the spectrum of causative organisms and antibiotic susceptibilities between healthcare-associated and community-acquired pneumonia. Physicians should differentiate patients with healthcare-associated pneumonia from those with community-acquired pneumonia to promote a targeted approach when selecting initial antibiotic therapy.
PMID: 18317041 [PubMed - indexed for MEDLINE]
A nice (and brief) review of nosocomial pneumonia. The authors incorporate Kollef’s data from BJH and some of their own data from Spain.
The article reviews recent evidence that the strict definition of “hospital acquired” pneumonia excludes patients with recent healthcare exposure who probably have similar microbial patterns to nosocomial patients. Included in “healthcare associated” pneumonia are patients who have been hospitalized within 90 days, undergo outpatient dialysis, and reside in extended care facilities.
Questions:
(1) Without a history of drug resistant organisms, do you routinely cover empirically for MRSA, drug resistant pneumococcus, and pseudomonas in dialysis and nursing home patients?
(2) In such patients who improve with empiric therapy, do you routinely commit them to parenteral therapy after discharge?