Antibiotic therapy of healthcare-associated pneumonia

The 2005 American Thoracic Society and Infectious Diseases Society of America (ATS/ IDSA) pneumonia guidelines incorporated for the first time a new concept of pneumonia called healthcare associated pneumonia (HCAP). This type of infection develops in patients, classically defined as "community acquired pneumonia", who have recent or chronic contact with the healthcare system and that appear to be at increased risk of infection with multi-drug resistant (MDR) pathogens. Recent studies have shown that this type of infection is distinct from "true CAP" in terms of epidemiology, etiology and clinical outcome. Analysis of multi-institutional clinical data showed that mortality in patients with HCAP is higher than those with CAP, and that HCAP patients have an increased likelihood to receive inappropriate initial antibiotic treatment. To increase the likelihood that appropriate initial antibiotic treatment will be prescribed, the selection of initial empiric therapy must be patient oriented and institution specific, and determined according to local prevalence and susceptibility patterns. A review of available clinical data about HCAP treatment was conducted to determine effective empiric antibiotic strategies in order to improve clinical outcomes.