Hospital-acquired pneumonia

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. Alveolar shadowing 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 multidrug-resistant pathogens.

Hospital-acquired pneumonia (HAP) is an acute lower respiratory tract infection that is by definition acquired after at least 48 hours of admission to the hospital and is not incubating at the time of admission.[1]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;63:e61-e111. http://cid.oxfordjournals.org/content/63/5/e61.long http://www.ncbi.nlm.nih.gov/pubmed/27418577?tool=bestpractice.com The spectrum of HAP is now distinct from ventilator-associated pneumonia (VAP), which is defined as pneumonia occurring more than 48 hours after endotracheal intubation. Healthcare-associated pneumonia (HCAP) is no longer considered a clinical entity in the most recent guidelines for HAP and VAP by the Infectious Diseases Society and the American Thoracic Society.