What is healthcare-associated pneumonia and how is it managed?

Abstract

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. 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. 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.