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PNEUMONIA - HOSPITAL-ACQUIRED
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.
Ventilator-associated pneumonia (VAP) is described as pneumonia occurring >48-72 hours after endotracheal intubation and within 48 hours after removal of endotracheal tube.
Early-onset HAP or VAP is the pneumonia occurring within the first 4 days of hospitalization that may be cause by antibiotic-sensitive bacteria that usually carries a better diagnosis.
Late-onset HAP or VAP is the pneumonia occurring after ≥5 days. It is likely caused by multidrug-resistant pathogens associated with increased mortality and morbidity.

Introduction

Healthcare-associated Pneumonia (HCAP)
  • Pneumonia occurring in any patient who was hospitalized w/in an acute care hospital for ≥2 days, w/in 90 days of the infection; resided in a nursing home/long-term care facility; received recent IV antibiotic therapy, chemotherapy or wound care w/in the past 30 days of the current infection; or attended a hospital or hemodialysis clinic

Definition

Hospital-acquired Pneumonia (HAP)
  • Defined as pneumonia occurring ≥48 hours after admission & excluding any infection that is incubating at the time of admission
Ventilator-associated Pneumonia (VAP)
  • Described as pneumonia occurring >48-72 hours after endotracheal intubation & w/in 48 hours after removal of endotracheal tube
Early-onset HAP or VAP
  • Pneumonia occurring w/in the first 4 days of hospitalization
  • May be caused by antibiotic-sensitive bacteria, usually carries a better prognosis
Late-onset HAP or VAP
  • Pneumonia occurring after ≥5 days
  • Likely to be caused by multidrug-resistant (MDR) pathogens, associated w/ increased mortality & morbidity

Signs and Symptoms

Typical Signs & Symptoms
  • Fever
  • Cough w/ or w/o sputum production
  • Purulent sputum
  • Dyspnea; shortness of breath (SOB)
  • Respiratory failure
Other Findings
  • Worsening oxygenation
  • Increased heart rate
  • Increased minute ventilation

Risk Factors

  • ≥5 days duration stay for the current hospitalization
  • High antibiotic resistance in the community or w/in the specific treatment unit
  • Antibiotics w/in the preceding 90 days
  • Immunosuppressive disease &/or therapy
  • Presence of healthcare-associated pneumonia (HCAP) risk factors:
    • Chronic dialysis w/in 30 days
    • Family member w/ multidrug-resistant (MDR)  organism
    • Home infusion therapy (including antibiotics)
    • Home wound care
    • Hospitalization for ≥2 days w/in the previous 90 days
    • Resident of nursing home/long-term care facility
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