Hospital-acquired pneumonia diagnostic criteria

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Editor(s)-in-Chief: C. Michael Gibson, M.S., M.D. ; Philip Marcus, M.D., M.P.H.

Overview

In hospitalised patient who develop respiratory symptoms and fever one should consider the diagnosis. The likelyhood increases when upon investigation symptoms are found of respiratory insufficiency, purulent secretions, newly developed infiltrate on the chest X-Ray, and increasing leucocyte count. If pneumonia is suspected material from sputum or tracheal aspirates are sent for cultures. In case of pleural effusion thoracentesis is performed for examination of pleural fluid. Ventilator associated pneumonia refers to pneumonia arising in patients who have stayed on a ventilator for more than 48–72 hours. Additionally, patients with health-care associated pneumonia who may require intubation should be treated as ventilator associated pneumonia. In suspected ventilator-associated pneumonia it has been suggested that bronchoscopy(BAL) is necessary because of the known risks surrounding clinical diagnoses.

Diagnostic Criteria of Hospital Acquired Pneumonia

Community acquired pneumonia should be distinguished from healthcare-associated pneumonia as these diseases have different causative organism, prognosis, diagnostic and treatment guidelines. According to the Infectious Diseases Society of America and the American Thoracic Society healthcare-associated pneumonia includes any patient who meet the below criteria

• Hospitalized in an acute care hospital for 2 or more days within 90 days of the infection;
• Resided in a nursing home or long-term care facility;
• Received recent intravenous antibiotic therapy, chemotherapy, or wound care within the past 30 days of the current infection;
• Attended a hospital or hemodialysis clinic

American Thoracic Society (ATS) and the Infectious Disease Society of America (IDSA) definitions of Hospital acquired pneumonia, ventilator-associated pneumonia, and health care associated pneumonia

“

Hospital-Acquired Pneumonia (HAP) HAP is defined as pneumonia that occurs 48 hours or more after admission, which was not incubating at the time of admission Ventilator-associated pneumonia (VAP) VAP refers to pneumonia that arises more than 48–72 hours after endotracheal intubation. Some patients may require intubation after developing severe HAP and should be managed similar to patients with VAP. Healthcare-Associated Pneumonia (HCAP) HCAP includes any patient who was hospitalized in an acute care hospital for two or more days within 90 days of the infection; resided in a nursing home or long-term care facility; received recent intravenous antibiotic therapy, chemotherapy, or wound care within the past 30 days of the current infection; or attended a hospital or hemodialysis clinic.

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