A Critical Evaluation of Healthcare-Associated Pneumonia and the Need for Anti-pseudomonal Therapy, Including Double Coverage

Abstract In 2005, healthcare-associated pneumonia (HCAP) was described as a distinct entity, reflecting the concern that patients with HCAP have mortality rates and microbiologic culprits more akin to patients with hospital-acquired pneumonia (HAP) and, thus, warrant treatment similar to HAP, including empiric broad spectrum antibiotics. Increasing evidence suggests that the HCAP definition and criteria are insufficient predictors of which patients are at highest risk of being infected with a multi-drug resistant organism (MDRO); this lack of accuracy leads to overuse of broad spectrum antibiotics. New risk stratification schemes have been proposed that may supplant our current reliance on HCAP criteria for identifying patients who may be infected with an MDRO. Regardless of the risk stratification method used, antibiotic decisions must account for local MDRO prevalence rates. In settings where P. aeruginosa resistance to anti-pseudomonal therapies is high or in patients who are critically ill, empiric combination therapy for P. aeruginosa may be considered. However, therapy should be narrowed to a single agent once an effective agent has been identified from culture susceptibility data.
Source: Current Emergency and Hospital Medicine Reports - Category: Emergency Medicine Source Type: research