สรุป

• A pneumonia acquired after 48 hours of admission to hospital.
• Most cases are caused by bacteria, especially aerobic gram-negative bacilli, such as Pseudomonas aeruginosa, Escherichia coli, Klebsiella pneumoniae, and Acinetobacter species.
• Patients with hospital-acquired pneumonia usually present with a combination of fever (or hypothermia), leukocytosis (or leukopenia), increased tracheal secretions, and poor oxygenation. An opacity on CXR or CT scan supports the diagnosis.
• A lower respiratory culture should be obtained before initiating antibiotics; result of the culture should be used to de-escalate antibiotics and focus on the offending pathogen.
• Broad-spectrum antimicrobials should be used initially for patients with risk factors for multi-drug-resistant pathogens.