Hospital-acquired pneumonia (non COVID-19)

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Última revisión: 21 Aug 2025
Última actualización: 19 Jun 2025

Resumen

Definición

Anamnesis y examen

Principales factores de diagnóstico

  • dyspnea
  • productive cough
  • fever
Todos los datos

Otros factores de diagnóstico

  • chest pain
  • asymmetric expansion of the chest
  • diminished resonance
  • egophony
  • whisper pectoriloquy
  • crackles or rhonchi
  • tachycardia
  • malaise/anorexia
Todos los datos

Factores de riesgo

  • poor infection control/hand hygiene
  • intubation and mechanical ventilation; endotracheal cuff pressure <20 cm H₂O
  • supine position
  • poor oral hygiene
  • sedation/no interruption in sedation
  • intubation/reintubation
Todos los datos

Pruebas diagnósticas

Primeras pruebas diagnósticas para solicitar

  • chest x-ray
  • WBC count with differential
  • pulse oximetry
  • culture of lower respiratory tract sample
Todos los datos

Pruebas diagnósticas que deben considerarse

  • ABG
  • diagnostic thoracentesis
  • CT chest
  • CRP
  • lung ultrasound
Todos los datos

Pruebas emergentes

  • MRSA nasal swab
Todos los datos

Algoritmo de tratamiento

Inicial

before culture results: without risk factors for multidrug-resistant (MDR) pathogen

before culture results: with risk factors for multidrug-resistant (MDR) pathogen, including Pseudomonas and MRSA

Agudo

after culture results: due to gram-negative pathogen

after culture results: due to gram-positive pathogen

Colaboradores

Consejeros especializados

Forest W. Arnold, DO, MSc, FIDSA

Professor of Medicine

Chief, Division of Infectious Diseases

Director Infectious Diseases Fellowship Training Program

Department of Medicine

School of Medicine

University of Louisville

Louisville

KY

Divulgaciones

FWA declares that he has no competing interests.

Revisores por pares

Krishna Sundar, MD, FCCP

Associate Professor (Clinical)

Department of Medicine

University of Utah

Director

Pulmonary and Critical Care Research

IHC Urban South

Utah Valley Pulmonary Clinic

UT

Divulgaciones

KS declares that he has no competing interests.

Ozan Akca, MD

Director of Research

Associate Professor

Department of Anesthesiology and Perioperative Medicine

Neuroscience and Anesthesia Intensive Care Unit

University of Louisville

Louisville

KY

Divulgaciones

OA declares that he has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

Referencias

Nuestros equipos internos de evidencia y editoriales colaboran con colaboradores expertos internacionales y revisores pares para garantizar que brindemos acceso a la información más clínicamente relevante posible.

Artículos principales

Kalil AC, Metersky ML, Klompas M, et al. Management of adults with hospital-acquired and ventilator-associated pneumonia: 2016 clinical practice guidelines by the Infectious Diseases Society of America and the American Thoracic Society. Clin Infect Dis. 2016 Sep 1;63(5):e61-111.Texto completo  Resumen

Klompas M, Branson R, Cawcutt K, et al. Strategies to prevent ventilator-associated pneumonia, ventilator-associated events, and nonventilator hospital-acquired pneumonia in acute-care hospitals: 2022 Update. Infect Control Hosp Epidemiol. 2022 Jun;43(6):687-713.Texto completo  Resumen

Artículos de referencia

Una lista completa de las fuentes a las que se hace referencia en este tema está disponible para los usuarios con acceso a todo BMJ Best Practice.
  • Hospital-acquired pneumonia (non COVID-19) images
  • Diferenciales

    • Coronavirus disease 2019 (COVID-19)
    • Cardiogenic pulmonary edema
    • Acute respiratory distress syndrome
    Más Diferenciales
  • Guías de práctica clínica

    • Strategies to prevent ventilator-associated pneumonia, ventilator-associated events, and nonventilator hospital-acquired pneumonia in acute-care hospitals
    • Management of adults with hospital-acquired and ventilator-associated pneumonia
    Más Guías de práctica clínica
  • Videos

    Supraglottic airway devices: animated demonstration

    Nasopharyngeal airway: animated demonstration

    Más vídeos
  • Folletos para el paciente

    Pneumonia

    Más Folletos para el paciente
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