Healthcare Associated Pneumonia (HCAP)....why is this important for the emergency physician?
Most of us are very familiar with the types of pneumonias commonly seen in clinical practice: community-acquired pneumonia (CAP), hospital-acquired pneumonia(HAP), and ventilator-associated pneumonia (VAP). But, some may not be that aware of a relatively newer type of pneumonia that has been well-defined, healthcare-associated pnemonia (HCAP). Experts in infectious disease and critical care now say that we (the ED) should be assessing ALL pneumonia patients for HCAP risk factors.
Why care, you ask?
Higher mortality than CAP
May look like CAP
Treated much differently than CAP
Risk factors: (most are common sense)
Nursing home or extended care facility resident
Recently admiited to a hospital for 2 or more days in the preceeding 90 days
Home wound care or attending a clinic for wound care
Dialysis patient
Home infusion therapy (antibiotics)
Immunosuppresive therapy or disease
Treatment:
3 drugs....not like treatment of CAP!
Usually a combination of a big gun anti-pseudomonal (e.g. Pip/Tazo) combined with a broad spectrum respiratory fluoroquinolone (e.g. Moxi), combined with Vancomycin
Key difference between treatment of CAP and HCAP is consideration for multi-drug resistant pathogens, pseudomonas, and MRSA.
