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
- A cough pleuritic chest pain
- Sputum production
- Less specific symptoms
- A headache
- Chest radiographs
- Chest ultrasound (US)
- 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.
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.
Hospital acquired pneumonia Diagnosis
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.
These imaging studies help in diagnosing or ruling out HAP.
Management of Hospital acquired pneumonia
A clinician should consider these steps if tests and imaging show that a patient has HAP.
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.