Hospital-acquired pneumonia
This is due to increasing evidence from a growing number of studies that many patients defined as having HCAP are not at high risk for MDR pathogens.
[11] One factor responsible for these differences is the reliance on sputum samples and the strictness of the criteria to discriminate between colonising or disease-causing bacteria.
[13] Aspiration (both of microscopic drops and macroscopic amounts of nose and throat secretions) is thought to be the most important cause of HCAP.
In general, the distribution of microbial pathogens varies among institutions, partly because of differences in patient population and local patterns of anti microbial resistance in hospitals and critical care units'[18] Common bacterial pathogens include aerobic GNB, such as Pseudomonas aeruginosa, Acinetobacter baumanii, Klebsiella pneumoniae, Escherichia coli as well as gram-positive organisms such as Staphylococcus aureus.
Hospital-acquired pneumonia can also be spread by health care workers, who can pass germs from their hands or clothes from one person to another.
[citation needed] In 2002, an expert panel made recommendations about the evaluation and treatment of probable nursing home-acquired pneumonia.
[22] They defined probably pneumonia, emphasized expedite antibiotic treatment (which is known to improve survival) and drafted criteria for the hospitalization of willing patients.
For initial treatment in the nursing home, a fluoroquinolone antibiotic suitable for respiratory infections (moxifloxacin, for example), or amoxicillin with clavulanic acid plus a macrolide has been suggested.
[12] Other factors that need to be taken into account are recent antibiotic therapy (because of possible resistance caused by recent exposure), known carrier state or risk factors for resistant organisms (for example, known carrier of MRSA or presence of bronchiectasis predisposing to Pseudomonas aeruginosa), or suspicion of possible Legionella pneumophila infection (legionnaires disease).
[26] For children and neonatal infants, different antibiotic approaches including cefepime, ceftazidime, linezolid, vancomycin, meropenem, cefotaxime, ceftobiprole, or cephalosporin are sometimes used.
[28][29][30] In patients with a limited life expectancy (for example, those with advanced dementia), end-of-life pneumonia also requires recognition and appropriate, palliative care.
[32] Besides clinical markers like tachypnea (fast breathing) or a high white cell count (leukocytosis), the prognosis seems to be influenced by the underlying associated diseases (comorbidities) and functional capacities (for example, the ADL score).
[25] Patients with HCAP are older and more commonly have simultaneous health problems (such as previous stroke, heart failure and diabetes).
[37][38] Among the factors contributing to contracting HAP are mechanical ventilation (ventilator-associated pneumonia), old age, decreased filtration of inspired air, intrinsic respiratory, neurologic, or other disease states that result in respiratory tract obstruction, trauma, (abdominal) surgery, medications, diminished lung volumes, or decreased clearance of secretions may diminish the defenses of the lung.
[1][2][3] Although gram-negative bacilli are a common cause they are rarely found in the respiratory tract of people without pneumonia, which has led to speculation of the mouth and throat as origin of the infection.
