Pneumonia - Hospital-Acquired Disease Summary

Overview

Hospital-acquired pneumonia (HAP) is defined as pneumonia occurring ≥48 hours after admission and excluding any infection that is incubating at the time of admission, as stated in the Introduction section.

Hospital-acquired pneumonia is one of the most common causes of nosocomial infection in hospitalized and intensive care patients, as stated in the Epidemiology section.

The Pathophysiology section states that hospital-acquired pneumonia develops from an imbalance of the normal host defenses and the ability of the microorganism to colonize and invade the lower respiratory tract.

Risk factors for hospital-acquired pneumonia, ventilator-associated pneumonia and multidrug-resistant pathogens are enumerated in the Risk Factors section.

Pneumonia - Hospital-Acquired_Disease Summary

History and Physical Examination

The Clinical Presentation section enumerates the typical signs and symptoms of hospital-acquired pneumonia.

Diagnosis

The Diagnosis or Diagnostic Criteria section features the Clinical Pulmonary Infection Score (CPIS) used to quantify clinical, radiographic, microbiologic, and physiological findings. This is important in the clinical decision-making process prior to antibiotic therapy, assessment of treatment response and antibiotic de-escalation.

Discussion on cultures, microbiologic techniques, and other tests is in the Laboratory Tests and Ancillaries section. Chest x-ray, as an aid in identifying disease severity and the presence of complications, are discussed in Imaging section.

Other diseases that can present with the same symptoms as hospital-acquired pneumonia are listed in the Differential Diagnosis section.

Management

The CURB65 scoring system for mortality risk assessment is stated in the Evaluation section. The need to assess patients for clinical response and other ancillary procedures during the course of antibiotic treatment and follow-up are also explained in this section.

Initiation of empiric therapy and choice of antibiotics are discussed in the Principles of Therapy section.

The Pharmacological Therapy section discusses in detail the empiric therapy of multidrug-resistant pathogen based on the presence or absence of risk factors.

The Nonpharmacological section explains the supportive therapy in the management of hospital-acquired pneumonia.

Recommended preventive measures for ventilator-associated pneumonia are in the Prevention section.

The Monitoring section discussed follow-up evaluation for patients treated for hospital-acquired pneumonia based on clinical improvement and response to therapy.