TY - JOUR
T1 - The alphabet soup of pneumonia
T2 - CAP, HAP, HCAP, NHAP, and VAP
AU - Anand, Nitin
AU - Kollef, Marin H.
PY - 2009/2
Y1 - 2009/2
N2 - 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.
AB - 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.
KW - Antibiotics
KW - Health care
KW - Multidrug-resistant
KW - Pneumonia
UR - http://www.scopus.com/inward/record.url?scp=60549098990&partnerID=8YFLogxK
U2 - 10.1055/s-0028-1119803
DO - 10.1055/s-0028-1119803
M3 - Review article
C2 - 19199181
AN - SCOPUS:60549098990
SN - 1069-3424
VL - 30
SP - 3
EP - 9
JO - Seminars in Respiratory and Critical Care Medicine
JF - Seminars in Respiratory and Critical Care Medicine
IS - 1
ER -