Current and Future Considerations for the Treatment of Hospital-Acquired Pneumonia

Abstract

Hospital-acquired pneumonia (HAP) and health-care-associated pneumonia (HCAP) are leading causes of death, morbidity, and resource utilization in hospitalized patients, and are associated with a broad range of Gram-positive and Gram-negative pathogens. Here, we discuss the different definitions of HAP and HCAP, review current guidelines regarding the treatment of these conditions, highlight the shortcomings of current therapeutic options, and discuss new antibiotic treatments. To optimize therapeutic outcomes in patients with HAP/HCAP, initial antimicrobial treatment must be appropriate and should be given as soon as possible; inappropriate or delayed therapy greatly increases morbidity and mortality. Selection of the most appropriate antimicrobial agent depends on the causative pathogen(s); initial broad-spectrum therapy is commonly recommended and should cover all pathogens that may be present. Treatment selection should also take into consideration the following factors: knowledge of underlying local risk factors for antimicrobial resistance, disease staging, and risk factors related to specific pathogens such as Pseudomonas aeruginosa, Acinetobacter spp., and methicillin-resistant Staphylococcus aureus (MRSA). Guidelines consistently emphasize the importance of treating HAP and HCAP with early and appropriate broad-spectrum antibiotics, and recent developments in this field have resulted in the availability of several additional treatment options. Telavancin shows potent activity against Gram-positive bacteria including MRSA and can be administered once daily; it was approved in the USA and European Union for the treatment of HAP after demonstrating non-inferiority to vancomycin. Ceftobiprole medocaril exhibits rapid antimicrobial activity against a broad range of both Gram-positive and Gram-negative pathogens, including MRSA. It was approved for the treatment of HAP (excluding ventilator-associated pneumonia) and community-acquired pneumonia in Europe in 2013. These new treatments may offer effective alternative therapeutic options for the management of HAP.FundingBasilea Pharmaceutica Ltd., Basel, Switzerland.Electronic supplementary materialThe online version of this article (doi:10.1007/s12325-016-0293-x) contains supplementary material, which is available to authorized users.

Nurses’ perception and attitudes towards oral care practices for mechanically ventilated patients

“…Our results are consistent with previous studies. 11 , 22 , 27 , 32 For instance, Jahansefat et al 36 claimed that the attitude of healthcare workers towards VAP prevention is not very positive, and Özveren and Özden 31 that 68.1% of the participants said that cleaning the oral cavity is a difficult and unpleasant task. However, our result is higher than Saddki et al 37 which revealed that 40.8% of the participants stated it was difficult and 16.2% unpleasant, using appropriate oral care methods and having positive oral care attitudes.…”

“… 9 , 19 One of the most effective oral care practices is brushing the patient’s mouth using chlorhexadine plus use of a broad-spectrum antibiotic agent. 1 , 9 , 20 - 22 The recommended frequency of performing oral care also varies: every 2 hours, 4 hours, 8 hours or 12 hours. 9 , 13 , 19 , 23 - 25 The literature did not confirm which was better for reducing the risk of VAP.…”

Microbial cause of ICU-acquired pneumonia: hospital-acquired pneumonia versus ventilator-associated pneumonia

“…HAP incidence ranges from 5 to more than 20 cases per 1000 hospital admissions, with the highest rates in immunocompromised, post-surgery and elderly patients [3,[40][41][42][43]. However, in contrast to VAP patients in whom it is relatively easy to collect distal respiratory secretions through the endotracheal tube as soon as the infection is suspected and before the introduction of any new antibiotics, obtaining reliable specimens from the lower respiratory tract for microbiological cultures in patients developing HAP is difficult and thus most of them are receiving new antibiotics before specimens can be obtained.…”

Inappropriate Use of Antimicrobials for Lower Respiratory Tract Infections in Elderly Patients: Patient- and Community-Related Implications and Possible Interventions

“…European studies tend to report community-like etiology, while studies from Asia and the US show increased MDRO rates in HCAP patients [ 25 – 28 ]. To date, the clinical relevance of HCAP remains unclear [ 23 , 24 ]. In fact, both Infectious Diseases Society of America (IDSA) and European Society of Clinical Microbiology and Infectious Diseases (ESCMID) guidelines do not address HCAP, which leaves a gap in the recommendations regarding treatment for patients from long-term care facilities (LTCFs).…”