Healthcare-associated pneumonia

Healthcare-associated pneumonia (HCAP) is a type of pneumonia that occurs in people who have had recent contact with the healthcare system, either through hospitalization, outpatient clinics, nursing homes, or long-term care facilities. Unlike community-acquired pneumonia (CAP), which is acquired in the community setting, HCAP is associated with a higher risk of being caused by multi-drug resistant bacteria, making its management more challenging.

Etiology

HCAP is caused by a wide range of pathogens, including bacteria, viruses, and fungi. The most common bacterial pathogens include Staphylococcus aureus (including MRSA), Pseudomonas aeruginosa, Klebsiella pneumoniae, and Escherichia coli. These pathogens are often more resistant to antibiotics than the bacteria commonly causing CAP, due to the frequent use of antibiotics in healthcare settings, which promotes resistance.

Risk Factors

Individuals at higher risk for HCAP include those with:

• Recent hospitalization (within the last 90 days)
• Residence in a nursing home or long-term care facility
• Recent outpatient treatment, including intravenous therapy, wound care, or chemotherapy
• Chronic dialysis within the last 30 days
• Immunosuppressive disease or therapy

Clinical Presentation

The symptoms of HCAP are similar to those of other types of pneumonia and can include:

• Fever
• Cough, which may produce phlegm
• Difficulty breathing or shortness of breath
• Chest pain
• Fatigue

Diagnosis

Diagnosis of HCAP involves a combination of clinical assessment, imaging, and microbiological testing. Chest X-ray or computed tomography (CT) scan can show infiltrates or other signs of pneumonia. Microbiological testing of respiratory secretions can help identify the causative pathogen and guide antibiotic therapy.

Treatment

Treatment of HCAP typically involves empirical antibiotic therapy initially, which is then adjusted based on microbiological testing results and the patient's clinical response. The choice of antibiotics is guided by local antibiotic resistance patterns and the severity of the patient's illness. In cases of suspected or confirmed multi-drug resistant pathogens, combination antibiotic therapy may be necessary.

Prevention

Preventive measures for HCAP include:

• Adherence to infection control practices in healthcare settings
• Appropriate use of antibiotics to reduce the development of resistance
• Vaccination against influenza and pneumococcal disease for at-risk populations

Prognosis

The prognosis of HCAP depends on several factors, including the patient's underlying health conditions, the causative pathogen, and the timeliness and appropriateness of the treatment. While many patients recover with appropriate treatment, HCAP can be severe and potentially life-threatening, especially in vulnerable populations.

See Also

• Hospital-acquired pneumonia
• Ventilator-associated pneumonia
• Antibiotic resistance
• Infection control