UMEM Educational Pearls

Category: Infectious Disease

Title: Healthcare Associated Pneumonia

Keywords: Pneumonia (PubMed Search)

Posted: 11/18/2008 by Rob Rogers, MD (Updated: 10/14/2019)
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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.