Hcap

Abstract

Health care-associated pneumonia (HCAP) includes a broad spectrum of patients who acquire pneumonia through outpatient contact with the health system. It has been suggested that HCAP merits a distinct therapeutic approach, because its epidemiology, causative organisms, and antibiotic susceptibilities may differ from those of community-acquired pneumonia, characterized by an excess of multidrug-resistant pathogens. 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 multidrug antibiotic regimen. Over the last few years there has been a controversy over whether HCAP is associated with more frequent drug-resistant pathogens (not in Europe) and whether the higher mortality is due to inappropriate therapy or the poor functional status of the HCAP patients. Further studies have shown that therapy consistent with HCAP treatment guidelines has also not been found to improve mortality. 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.