Adding fuel to the flames? It is time to leave HCAP

Ewig, Santiago; Welte, Tobias

doi:10.1016/j.rmed.2012.07.002

Cited by 9 publications

(5 citation statements)

References 25 publications

(13 reference statements)

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“…85 Since publication of the guidelines, widespread adoption of the HCAP concept without consideration of local epidemiology has led to a vast overuse of inappropriately broad spectrum antibiotics (particularly vancomycin and β lactam/β lactamase combinations) despite little evidence that these are needed outside of major urban centers in the US. [88][89][90][91] The CDC EPIC study, which included some patients with risk factors for HCAP in two major urban centers, found less than 3% of cases with MRSA or Pseudomonas. 19 In addition, retrospective analyses have shown that empiric treatment for patients with the original HCAP risk factors is associated with no better or even worse mortality than treatment with usual CAP therapy.…”

Section: Optimal Antibiotic Managementmentioning

confidence: 99%

“…[88][89][90][91][92][93][94][95][96] Clinicians must be aware of their local ecology and whether studies id entifying risk low. The trial failed to show that monotherapy was noninferior in terms of time to clinical stability; only 34% (97/289) of monotherapy patients had reached clinical stability at day seven of therapy compared with 41% (120/291) for combination therapy, with the upper limit of the one sided 95% confidence interval (13%) exceeding the pre-specified boundary of 8%.…”

Section: Optimal Antibiotic Managementmentioning

confidence: 99%

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Advances in the causes and management of community acquired pneumonia in adults

Wunderink

Waterer

2017

BMJ

158

112

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Community acquired pneumonia remains a common cause of morbidity and mortality. Usually, the causal organism is not identified and treatment remains empiric. Recent computed tomography and magnetic resonance imaging studies have challenged the accuracy of the clinical diagnosis of pneumonia, and epidemiologic studies are changing our perspective of what causes community acquired pneumonia, especially the role of viral pathogens and the frequent finding of multiple pathogens. The past decade has seen increasing overuse of empiric coverage of meticillin resistant and antibiotic resistant Gram negative pathogens owing to inappropriate application of guidelines for healthcare associated pneumonia. Optimal treatment remains a matter for debate, especially in very sick patients, including the role of combination antibiotic therapy and corticosteroids. Pneumonia care bundles are being defined to improve outcomes. Increased recognition of both acute and long term cardiac complications is shifting our concept of pneumonia from an acute lung disease to a multisystem problem with adverse chronic health consequences.

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Section: Optimal Antibiotic Managementmentioning

confidence: 99%

Section: Optimal Antibiotic Managementmentioning

confidence: 99%

Advances in the causes and management of community acquired pneumonia in adults

Wunderink

Waterer

2017

BMJ

158

112

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“…The characteristics of our current societies, such as increased environmental pollution and overcrowding, may be aggravating factors for the increase of pneumonic episodes in vulnerable individuals, as well as the increased life expectancy in developed countries [ 2 ]. Healthcare-associated pneumonia (HCAP) has been introduced as an entity in the ATS/IDSA guidelines update from 2005 [ 31 ] and still is a controversy concept, especially in Europe [ 32 , 33 , 34 ] considering the difficulty to identify predictors for such risk [ 35 ].…”

Section: Discussionmentioning

confidence: 99%

Epidemiological Characterization and the Impact of Healthcare-Associated Pneumonia in Patients Admitted in a Northern Portuguese Hospital

Méndez

Castro

Ferreira

et al. 2021

JCM

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Pneumonia is one of the main causes of hospitalization and mortality. It’s the fourth leading cause of death worldwide. Healthcare-associated infections are the most frequent complication of healthcare and affect hundreds of millions of patients around the world, although the actual number of patients affected is unknown due to the difficulty of reliable data. The main goal of this manuscript is to describe the epidemiological characteristics of patients admitted with pneumonia and the impact of healthcare-associated pneumonia (HCAP) in those patients. It is a quantitative descriptive study with retrospective analysis of the clinical processes of 2436 individuals for 1 year (2018) with the diagnosis of pneumonia. The individuals with ≤5 years old represented 10.4% (n = 253) and ≥65 were 72.6% (n = 1769). 369 cases resulted in death, which gives a sample lethality rate of 15.2%. The severity and mortality index were not sensitive to the death event. We found 30.2% (n = 735) individuals with HCAP and 0.41% (n = 59) with ventilator-associated pneumonia (VAP). In only 59 individuals (2.4%) the agent causing pneumonia was isolated. The high fatality rate obtained shows that pneumonia is a major cause of death in vulnerable populations. Moreover, HCAP is one of the main causes of hospital admissions from pneumonia and death and the most pneumonias are treated empirically. Knowledge of the epidemiology characterization of pneumonia, especially associated with healthcare, is essential to increase the skills of health professionals for the prevention and efficient treatment of pneumonia.

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“…Traditional approaches include three basic categories: community, hospital and health-care associated pneumonia. The first and second term have been used for a long time; the third was mainly based on early results published by Kollef et al [12] that were not reproduced [13,14]. Thus, both guidelines recommend abandoning this term as it is confusing and is not clear that this type of patients are associated with an increased risk of resistant microorganism.…”

Section: Scope and Definitionsmentioning

confidence: 99%

Community-acquired pneumonia: similarities and differences between European and American guidelines – A narrative review –

2020

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Community-acquired pneumonia (CAP) is severe disease. Early prescription of an adequate treatment has a positive impact in the CAP outcome. Despite the evidence of existing relevant differences between CAP across geographical areas, general guidelines can be designed to be applied everywhere. Eight years have passed between the publication of the European (EG) and American (AG) CAP guidelines, thus the aim of this narrative review is to compare both guidelines and summarize their recommendations. The main similarity between both guidelines is the antibiotics recommendation with the exception that AG mention new antimicrobials that were not available at the time of EG publication. Both guidelines recommend against routinely adding steroids as an adjuvant treatment. Finally, both guidelines acknowledge that the decision to hospitalize a patient is clinical and should be complemented with an objective tool for risk assessment. EG recommend the CRB-65 while AG recommend the Pneumonia Severity Index (PSI). EG and AG share a similar core of recommendations and only differ in minor issues such as new antibiotics. Likewise, both guidelines recommend against the routine prescription of steroids as an adjuvant therapy.

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Adding fuel to the flames? It is time to leave HCAP

Cited by 9 publications

References 25 publications

Advances in the causes and management of community acquired pneumonia in adults

Advances in the causes and management of community acquired pneumonia in adults

Epidemiological Characterization and the Impact of Healthcare-Associated Pneumonia in Patients Admitted in a Northern Portuguese Hospital

Community-acquired pneumonia: similarities and differences between European and American guidelines – A narrative review –

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