Healthcare-associated pneumonia is a heterogeneous disease, and all patients do not need the same broad-spectrum antibiotic therapy as complex nosocomial pneumonia

@article{Brito2009HealthcareassociatedPI,
  title={Healthcare-associated pneumonia is a heterogeneous disease, and all patients do not need the same broad-spectrum antibiotic therapy as complex nosocomial pneumonia},
  author={Veronica Brito and Michael S. Niederman},
  journal={Current Opinion in Infectious Diseases},
  year={2009},
  volume={22},
  pages={316–325}
}
Purpose of review Healthcare-associated pneumonia (HCAP) develops in patients who have recently had contact with nosocomial and drug-resistant pathogens, because of a history of hospitalization in the past 90 days, need for hemodialysis or home wound care, or residence in a nursing home. HCAP was included in the 2005 American Thoracic Society/Infectious Diseases Society of America guidelines for nosocomial pneumonia, with the recommendation that all such patients receive empiric therapy with a… 
Low incidence of multidrug-resistant organisms in patients with healthcare-associated pneumonia requiring hospitalization.
  • C. García-Vidal, D. Viasus, J. Carratalá
  • Medicine, Biology
    Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases
  • 2011
TLDR
Most HCAP patients could be treated in the same way as patients with CAP, after carefully ruling out the presence of aspiration pneumonia, and no differences were found regarding inappropriate initial empirical antibiotic therapy between groups.
Is healthcare-associated pneumonia a distinct entity needing specific therapy?
TLDR
The HCAP concept results in a tremendous overtreatment without any evidence for improved outcomes, and should not be implemented in clinical practice prior to clear evidence that it is superior to a careful assessment of individual risk factors for MDR pathogens.
HCAP: A Worldwide Perspective
TLDR
The heterogeneity of the HCAP concept affords patients a different treatment approach based on assessment of individual risk factors for multidrug resistance pathogens, but does not seem to be confirmed on the basis of current evidence from the literature.
Clinical impact of broad-spectrum empirical antibiotic therapy in patients with healthcare-associated pneumonia: a multicenter interventional study
TLDR
The results suggest that an empirical broad-spectrum therapy is associated with improved outcome in patients with HCAP, and main measures for improvement were duration of antibiotic therapy, length of hospital stay, and in-hospital mortality rate.
The definition of healthcare-associated pneumonia (HCAP) is insufficient for the medical environment in Japan: a comparison of HCAP and nursing and healthcare-associated pneumonia (NHCAP)
  • N. Kaku, K. Yanagihara, S. Kohno
  • Medicine, Biology
    Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy
  • 2013
TLDR
Some Japanese patients, who were consistent with the concept of HCAP, were classified as community-acquired pneumonia (CAP) and there is a need to change the definition ofHCAP according to the medical environment in Japan.
Community-acquired pneumonia: current data
TLDR
It seems that the classic triad can include all pneumonia categories but there is certainly the need to include also new conditions that concern the great increase of elderly patients and the need for evaluation of the functional status and the aspiration that were not till now taken into account.
Intermediate risk of multidrug-resistant organisms in patients who admitted intensive care unit with healthcare-associated pneumonia
TLDR
MDR pathogens were isolated in HCAP patients requiring ICU admission at intermediate rates between those of CAP and HAP, compared to patients withcommunity-acquired pneumonia (CAP) or hospital-acquires pneumonia (HAP.
A retrospective study of health care-associated pneumonia patients at Aichi Medical University hospital
  • Y. Yamagishi, H. Mikamo
  • Medicine, Biology
    Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy
  • 2011
TLDR
Since the causative organisms of HCAP were closely related to those of hospital-acquired pneumonia and not to community- Acquired pneumonia, it is believed that aggressive chemotherapy using broad-spectrum antimicrobials is needed in the initial treatment.
Clinical characteristics of nursing and healthcare-associated pneumonia: a Japanese variant of healthcare-associated pneumonia.
TLDR
It is thought to be of benefit to modify the healthcare-associated pneumonia (HCAP) criteria considering the healthcare and social health insurance system in Japan.
Epidemiology, antibiotic therapy, and clinical outcomes in health care-associated pneumonia: a UK cohort study.
  • J. Chalmers, Joanne K. Taylor, A. Hill
  • Medicine, Biology
    Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
  • 2011
TLDR
This study recorded the clinical features, microbiology, and outcomes in a UK cohort of hospitalized patients with pneumonia, finding that HCAP is common in the United Kingdom and is associated with a high mortality.
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References

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TLDR
At present, a substantial number of patients initially seen with pneumonia in the emergency department have HCAP, and these patients require a targeted approach when selecting empirical antibiotic therapy.
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TLDR
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