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Healthcare-asociated pneumonia:Any reasons to still utilize this label in 2019?
Clin Microbiol Infect. 2019 Feb 27;:
Authors: Ewig S, Kolditz M, Pletz MW, Chalmers J
Abstract
BACKROUND: There is an ongoing controversy on the role of the HCAP label in the treatment of patients with pneumonia.
OBJECTIVE: To provide an update of the literature on patients meeting criteria for healthcare-associated pneumonia 2014-2018.
SOURCES: The review was based on a systematic literature search using Pub Med-Central full-text archive of biomedical and life sciences journal literature at the U.S. National Institutes of Health's National Library of Medicine (NIH/NLM).
CONTENT: Studies compared clinical characteristics of HCAP and CAP patients, with HCAP patients being older and having a higher comorbidity. Mortality rates in HCAP varied from 5 to 33% but seemed lower than those reported in the initial reports. Criteria behind the classification as HCAP differed considerably within populations. Microbial patterns differed in that there was a higher incidence in MRSA and P.aeruginosa, and, to a lesser extent, enterobacteriaceae. Definitions and rates of MDR pneumonia also varied considerably. Broad spectrum guideline-concordant treatment did not reduce mortality in four observational studies. The HCAP criteria performed poorly as a predictive tool to identify MDR or pathogens not covered by treatment for community-acquired pneumonia. A new score (DRIP) outperformed HCAP in the prediction of MDR pathogens. Comorbidity and functional status but not different microbial patterns seem to account for increased mortality.
IMPLICATIONS: HCAP should no longer be used to identify patients at risk of MDR pathogens. The use of validated predictive scores along with implementation of deescalation strategies and careful individual assessment of comorbidity and functional status seem superior strategies for the clinical management.
PMID: 30825674 [PubMed - as supplied by publisher]