Management of Health-Care Associated Pneumonia (HCAP)

Traditional Classification ◽

Introduction The traditional classification of Pneumonia as either community acquired (CAP) or hospital acquired (HAP) reflects deep differences in the etiology, pathogenesis, approach and prognosis between the two entities. Health-Care Associated Pneumonia (HCAP) develops in a heterogeneous group of patients receiving invasive medical care or surgical procedures in an outpatient setting. For epidemiology and outcomes, HCAP closely resembles HAP and possibly requires an analogous therapeutic regimen effective against multidrug-resistant pathogens. Materials and methods We reviewed the pertinent literature and the guidelines for the diagnosis and management of HCAP to analyze the evidence for the recommended approach. Results Growing evidence seems to confirm the differences in epidemiology and outcome between HCAP and CAP but fails to confirm any real advantage in pursuing an aggressive treatment for all HCAP and CAP patients. Discussion Further investigations are needed to establish the optimal treatment approach according to the different categories of patients and the different illness severities. Keywords Health Care Associated Pneumonia (HCAP); Community Acquired Pneumonia (CAP); Hospital Acquired Pneumonia (HAP); Multidrug-resistant (MDR) Pathogens

Hospital‐Acquired Pneumonia, Health Care–Associated Pneumonia, Ventilator‐Associated Pneumonia, and Ventilator‐Associated Tracheobronchitis: Definitions and Challenges in Trial Design

Clinical Infectious Diseases ◽

10.1086/653035 ◽

2010 ◽

Vol 51 (S1) ◽

pp. S12-S17 ◽

Cited By ~ 49

Author(s):

Michael S. Niederman

Keyword(s):

Health Care ◽

Trial Design ◽

Ventilator Associated Pneumonia ◽

Pulmonary and Mycobacterial Infections

Mayo Clinic Internal Medicine Board Review ◽

10.1093/med/9780190464868.003.0045 ◽

2016 ◽

pp. 505-520

Author(s):

Pritish K. Tosh ◽

Elie F. Berbari

Keyword(s):

Health Care ◽

Intensive Care Unit ◽

Bacterial Infections ◽

Mortality Rates ◽

High Morbidity ◽

Therapeutic Approaches ◽

Mycobacterial Infections ◽

Hospital-acquired pneumonia (HAP), ventilator-associated pneumonia (VAP), and health care–associated pneumonia (HCAP) cause 25% of all infections in the intensive care unit and are the basis for 50% of all antimicrobials prescribed in the hospital. These are primarily bacterial infections and are associated with high morbidity and mortality rates. However, pneumonias occurring before the fifth day of hospitalization are generally caused by organisms that are more susceptible to antimicrobials and have a better prognosis than those occurring on or after the fifth hospital day. The diagnostic and therapeutic approaches to HAP, VAP, and HCAP are similar.

Ceftaroline Fosamil for Treatment of Methicillin-Resistant Staphylococcus aureus Hospital-Acquired Pneumonia and Health Care–Associated Pneumonia

Infectious Diseases in Clinical Practice ◽

10.1097/ipc.0000000000000372 ◽

2016 ◽

Vol 24 (2) ◽

pp. 87-91 ◽

Cited By ~ 6

Author(s):

Samia Arshad ◽

Pamela Hartman ◽

Mary Beth Perri ◽

Daniela Moreno ◽

Marcus J. Zervos

Keyword(s):

Health Care ◽

Staphylococcus Aureus ◽

Methicillin Resistant Staphylococcus Aureus ◽

Ceftaroline Fosamil ◽

Methicillin Resistant ◽

Guidelines for hospital-acquired pneumonia and health-care-associated pneumonia: a vulnerability, a pitfall, and a fatal flaw

The Lancet Infectious Diseases ◽

10.1016/s1473-3099(11)70005-6 ◽

2011 ◽

Vol 11 (3) ◽

pp. 248-252 ◽

Cited By ~ 32

Author(s):

Victor L Yu

Keyword(s):

Health Care ◽

Fatal Flaw ◽

Faculty Opinions recommendation of Relationship of vancomycin minimum inhibitory concentration to mortality in patients with methicillin-resistant Staphylococcus aureus hospital-acquired, ventilator-associated, or health-care-associated pneumonia.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.13485007.14862130 ◽

2012 ◽

Author(s):

George Sakoulas

Keyword(s):

Health Care ◽

Staphylococcus Aureus ◽

Minimum Inhibitory Concentration ◽

Methicillin Resistant Staphylococcus Aureus ◽

Inhibitory Concentration ◽

Methicillin Resistant ◽

Vancomycin Minimum Inhibitory Concentration ◽

Hospital Acquired ◽

Relationship Of

Community-Acquired Pneumonia and Health Care-Associated Pneumonia Clinical Guidelines

Essential Practice Guidelines in Primary Care - Current Clinical Practice ◽

10.1007/978-1-59745-313-4_8 ◽

2007 ◽

pp. 103-117

Author(s):

John Russell

Keyword(s):

Health Care ◽

Clinical Guidelines ◽

Health Care Associated Pneumonia

Prospective, comparative clinical study between high-dose colistin monotherapy and colistin–meropenem combination therapy for treatment of hospital-acquired pneumonia and ventilator-associated pneumonia caused by multidrug-resistant Klebsiella pneumoniae

Journal of Global Antimicrobial Resistance ◽

10.1016/j.jgar.2018.07.003 ◽

2018 ◽

Vol 15 ◽

pp. 127-135 ◽

Cited By ~ 6

Author(s):

Mohamed Farouk Ahmed Abdelsalam ◽

Maged Salah Abdalla ◽

Hanan Salah El-Din El-Abhar

Keyword(s):

Clinical Study ◽

Combination Therapy ◽

Klebsiella Pneumoniae ◽

Multidrug Resistant ◽

High Dose ◽

Ventilator Associated Pneumonia ◽

Comparative Clinical Study ◽

Pulmonary Infections

Chest Imaging ◽

10.1093/med/9780199858064.003.0033 ◽

2019 ◽

pp. 187-189

Author(s):

Santiago Martínez-Jiménez

Keyword(s):

Antibiotic Therapy ◽

Treatment Failure ◽

Clinical Response ◽

Chest Radiography ◽

Clinical Perspective ◽

Immunosuppressed Patients ◽

Healthcare Associated ◽

Pneumonia can be classified as: community-acquired pneumonia (CAP), hospital-acquired pneumonia (HAP), ventilator-associated pneumonia (VAP), healthcare-associated pneumonia (HCAP), and pneumonia in immunosuppressed patients. Although the above are similar pathologically, they are very different from a clinical perspective. Chest radiography is often performed to support the diagnosis and to determine the extent of involvement prior to the onset of therapy. Radiography should not be performed in the short term in patients who are improving clinically as it can lead to the misdiagnosis of treatment failure. Chest radiography in patients treated for pneumonia should only be obtained before 4-6 weeks after the onset of therapy if there is a failure of clinical response or if complications of pneumonia are clinically suspected. The majority of pneumonias will resolve after 6 weeks of appropriate antibiotic therapy.

Clinical characteristics of patients with pneumonia caused by Klebsiella pneumoniae in Taiwan and prevalence of antimicrobial-resistant and hypervirulent strains: a retrospective study

Antimicrobial Resistance and Infection Control ◽

10.1186/s13756-019-0660-x ◽

2020 ◽

Vol 9 (1) ◽

Cited By ~ 2

Author(s):

Chih-Han Juan ◽

Shih-Yu Fang ◽

Chia-Hsin Chou ◽

Tsung-Ying Tsai ◽

Yi-Tsung Lin

Keyword(s):

Retrospective Study ◽

Klebsiella Pneumoniae ◽

Clinical Characteristics ◽

Drug Resistant ◽

Resistant Strains ◽

Healthcare Associated ◽

Drug Resistant Strains ◽

Abstract Background We aimed to compare the clinical characteristics of patients with community-acquired pneumonia (CAP), healthcare-associated pneumonia (HCAP), and hospital-acquired pneumonia (HAP) caused by Klebsiella pneumoniae and analyze the antimicrobial resistance and proportion of hypervirluent strains of the microbial isolates. Methods We conducted a retrospective study on patients with pneumonia caused by K. pneumoniae at the Taipei Veterans General Hospital in Taiwan between January 2014 and December 2016. To analyze the clinical characteristics of these patients, data was extracted from their medical records. K. pneumoniae strains were subjected to antimicrobial susceptibility testing, capsular genotyping and detection of the rmpA and rmpA2 genes to identify hypervirulent strains. Results We identified 276 patients with pneumonia caused by K. pneumoniae, of which 68 (24.6%), 74 (26.8%), and 134 (48.6%) presented with CAP, HCAP, and HAP, respectively. The 28-day mortality was highest in the HAP group (39.6%), followed by the HCAP (29.7%) and CAP (27.9%) groups. The HAP group also featured the highest proportion of multi-drug resistant strains (49.3%), followed by the HCAP (36.5%) and CAP groups (10.3%), while the CAP group had the highest proportion of hypervirulent strains (79.4%), followed by the HCAP (55.4%) and HAP groups (41.0%). Conclusion Pneumonia caused by K. pneumoniae was associated with a high mortality. Importantly, multi-drug resistant strains were also detected in patients with CAP. Hypervirulent strains were prevalent in all 3 groups of pneumonia patients, even in those with HAP.