Health care-associated pneumonia: Meeting the clinical challenges

摘要

The risk factors for health care-associated pneumonia (HCAP) include hospitalization for 2 or more days within the past 90 days, residence in a nursing home or extended-care facility, home infusion therapy, and long-term dialysis within the past 30 days. Distinguishing between community-acquired pneumonia (CAP) and HCAP is important because of the implications for therapy. Compared with CAP, HCAP is more likely to be caused by multidrug-resistant organisms and is associated with a higher mortality rate. The management of HCAP requires antimicrobial coverage of Pseudomonas aeru-ginosa, Acinetobacter species, extended-spectrum fi-lactamase-producing Enterobacteriaceae, and methicilHn-resistant Staph-ylococcus aureus. Empirical narrowing of therapy is probably safe in patients with culture-negative HCAP who have improved with broad-spectrum therapy.