What is healthcare-associated pneumonia, and how should it be treated?

Abstract

In contrast to patients at risk for hospital-acquired pneumonia or mechanically ventilated patients at risk for ventilator-associated pneumonia, healthcare-associated pneumonia is a relatively new clinical entity that includes a spectrum of adult patients who have close association with acute care hospitals or reside in chronic care settings that increase their risk for pneumonia caused by multi-drug-resistant bacteria. Multi-drug-resistant pathogens include methicillin-resistant Staphylococcus aureus and Gram-negative bacilli, such as Pseudomonas aeruginosa, extended-spectrum beta-lactamase-producing Klebsiella pneumoniae, and Acinetobacter species. New guidelines for the management and prevention of hospital-acquired pneumonia, ventilator-associated pneumonia and healthcare-associated pneumonia from the American Thoracic Society and the Infectious Diseases Society of America were published in 2005 and are highlighted in this article. Recent data indicate that types of multi-drug-resistant pathogens may vary in different healthcare settings, and that individuals infected with multi-drug-resistant pathogens are more likely to receive inappropriate initial antibiotic therapy, which may result in poorer outcomes in terms of patient morbidity, mortality and increased length of hospital stay. This review highlights key points in the new recommendations and principles for initiating, de-escalating and stopping antibiotic therapy in individuals with healthcare-associated pneumonia. Widespread implementation of these guidelines is needed in healthcare institutions in order to reduce patient morbidity, mortality, and healthcare costs.