ABSTRACT
The classification of pneumonia is increasingly complex as the patient population
becomes more diverse. More and more patients are identified with pneumonia attributed
to multidrug-resistant (MDR) bacteria, occurring both in the hospital setting and
outside of the hospital. This is likely related to the expanding pool of patients
at risk for colonization with MDR bacteria. These expanding patient populations include
individuals residing in nonhospital health care facilities (e.g., long-term nursing
facilities, assisted living environments, rehabilitation centers), patients undergoing
outpatient procedures or therapies (hemodialysis, wound care, infusion therapy), patients
who have been recently discharged from the hospital setting, and those with significant
underlying immunosuppression. Patients exposed to these nonhospital risks who develop
pneumonia have traditionally been categorized as having community-acquired pneumonia
(CAP). However, the new designation for pneumonia acquired in these environments is
healthcare-associated pneumonia (HCAP). Additionally, some authors have categorized
patients in nursing homes as developing nursing home–acquired pneumonia (NHAP) because
there may be distinct epidemiological associations with this infection. Although HCAP
is currently treated with the same protocols as CAP in many hospitals, recent evidence
indicates that HCAP differs from CAP with respect to pathogens and prognosis, and
in fact, more closely resembles hospital-acquired pneumonia (HAP) and ventilator-associated
pneumonia (VAP) requiring broader empirical antimicrobial therapy than CAP.
KEYWORDS
Health care - pneumonia - multidrug-resistant - antibiotics
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Marin H KollefM.D.
Division of Pulmonary and Critical Care Medicine, Washington University School of
Medicine
660 South Euclid Ave., Campus Box 8052, St. Louis, MO 63110
eMail: mkollef@im.wustl.edu
