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Hospital-Acquired  Pneumonia

Hospital-acquired pneumonia (HAP) is the infection of the lower respiratory tract that a patient acquires after hospital admission. HAP occurs at least 48 hours after hospitalization and was not incubating during the time that a patriot goes to the hospital. This type of pneumonia can be severe and at times might become fatal.

The spectrum of HAP is now distinct from ventilator-associated pneumonia (VAP), which is 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.

Causes of Hospital-Acquired Pneumonia

Most HAP cases occur due to bacteria more so the aerobic gram-negative bacilli such as Escherichia coli, as Pseudomonas aeruginosa , Acinetobacterspecie or Klebsiella pneumonia.

These risk factors increase the chances of acquiring HAP.

  • Placement in a breathing machine
  • Presence of chronic lung disease
  • Chest or another type of major surgery
  • Weakened immune system due to cancer treatment, severe wounds, and specific medicine
  • Food or breath saliva into the lungs in patients who is not completely alert or suffering from swallowing problems such as after a stroke attack
  • Alcohol abuse
  • Old age
  • Health workers if the clothing they wear when attending a patient have come into contact HAP causing bacteria
  • Signs and symptoms of Hospital-Acquired Pneumonia

    Patients with hospital-acquired pneumonia exhibit a combination of fever, (hypothermia), increased tracheal secretions, leukocytosis(or leucopenia)and inadequate oxygenation. These other clinical features manifest as other forms of pneumonia.

    • Dyspnea
    • A cough pleuritic chest pain
    • Sputum production
    • Less specific symptoms
    • Rigors
    • Fevers
    • Chills
    • Fatigue
    • Nausea
    • A headache
    • Diarrhea
    • Vomiting
    • Myalgias
    • Hospital acquired pneumonia Diagnosis

      Lab studies

      The basis of pneumonia diagnosis is on clinical evidence and radiographic findings but not specifically on lab evidence. Lab studies support or refute a clinical assessment, and CBC is especially crucial for assessing HAP. Leukopenia or leukocytosis is non-specific for pneumonia, but they still help in the etiology of infectious diseases such as pneumonia.

      IDSA/ATS recommends a non-invasive sampling of sputum such as endotracheal aspirate for HAP diagnosis instead of invasive sampling like bronchoscopy. The recommendations do not support the use of C-reactive protection, procalcitonin and CPIS score as a form of diagnosis.

      The evidence of HAP cultures is limited as only a few patients are bacteremic although they can provide additional guidance for treatment and a de-escalation of the organism-specific antibiotic therapy.

      Imaging studies

      These imaging studies help in diagnosing or ruling out HAP.

      • CT
      • Chest radiographs
      • Chest ultrasound (US)
      • Management of Hospital acquired pneumonia

        A clinician should consider these steps if tests and imaging show that a patient has HAP.

      • Establish hemodynamic or respiratory support for unstable patients
      • Review local antibiogram for any resistance patterns
      • Determine risk of infection with MRSA and the need for antibiotics targeting MRSA
      • Establish the risk of mortality. One antipseudomonal antibiotic treatment is enough if the risk is low. High mortality risk cases require treatment with two antipseudomonal antibiotics but from different classes.
      • Consider empiric treatment like above during the initial treatment especially when microbiologic studies are still pending. A clinician should narrow and de-escalate antibiotics according to the culture identification of microorganisms and sensitive.