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| {{Pneumonia}}
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| '''Editor(s)-in-Chief:''' [[C. Michael Gibson, M.S., M.D.]] [mailto:mgibson@perfuse.org] Phone:617-632-7753; [[Philip Marcus, M.D., M.P.H.]][mailto:pmarcus192@aol.com] | | '''For the main page on pneumonia, click [[pneumonia|here]].''' |
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| ==Overview==
| | '''For community-acquired pneumonia, click [[community-acquired pneumonia|here]].''' |
| '''Hospital-acquired pneumonia''' (HAP) or '''Health-Care associate pneumonia''' (HCAP) refers to any [[pneumonia]] contracted within 48-72 hours of being admitted in hospital. It is usually caused by a bacterial infection.<ref name="Mandell"> | |
| [http://www.ppidonline.com/ Mandell's Principles and Practices of Infection Diseases] 6th Edition (2004) by Gerald L. Mandell MD, MACP, John E. Bennett MD, Raphael Dolin MD, ISBN 0-443-06643-4 · Hardback · 4016 Pages Churchill Livingstone</ref><ref name="Oxford">[http://www.oup.com/us/catalog/general/subject/Medicine/PrimaryCare/?ci=0192629220&view=usa The Oxford Textbook of Medicine] Edited by David A. Warrell, Timothy M. Cox and John D. Firth with Edward J. Benz, Fourth Edition (2003), [[Oxford University Press]], ISBN 0-19-262922-0</ref>
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| Following [[urinary tract infection]]s, this is the second common cause of [[nosocomial infection]]s, and its prevalence is 15-20% of the total number.<ref name="Mandell"/><ref name="Oxford"/><ref name="Harrison"> [http://books.mcgraw-hill.com/medical/harrisons/ Harrison's Principles of Internal Medicine] 16th Edition, The [[McGraw-Hill]] Companies, ISBN 0-07-140235-7</ref> It is the most common cause of death among nosocomial infections, while in the intensive care unit it is the primary cause of death.<ref name="Mandell"/><ref name="Harrison"/>
| | '''For patient information, click [[Hospital-acquired pneumonia (patient information)|here]].''' |
| | {{Hospital-acquired pneumonia}} |
| | {{CMG}}; '''Associate Editor(s)-In-Chief:''' [[Priyamvada Singh|Priyamvada Singh, M.D.]] [mailto:psingh13579@gmail.com]; {{AL}} |
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| [[Ventilator-associated pneumonia]] (VAP) is a subset of hospital-acquired pneumonia. VAP is pneumonia which occurs after at least 48 hours of [[intubation]] and [[mechanical ventilation]]. | | ==[[Hospital-acquired pneumonia overview|Overview]]== |
| | ==[[Hospital-acquired pneumonia historical perspective|Historical Perspective]]== |
| | ==[[Hospital-acquired pneumonia pathophysiology|Pathophysiology]]== |
| | ==[[Hospital-acquired pneumonia causes|Causes]]== |
| | ==[[Hospital-acquired pneumonia differential diagnosis|Differentiating Hospital-Acquired Pneumonia from other Diseases]]== |
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| ==Pathogenesis== | | ==[[Hospital-acquired pneumonia epidemiology and demographics|Epidemiology and Demographics]]== |
| Most nosocomial respiratory infections are caused by so-called skorvatch microaspiration of upper airway secretions, through inapparent [[aspiration]], into the lower respiratory tract. Also, "macroaspirations" of esophageal or gastric material is known to result in HAP. Since it results from aspiration either type is called [[aspiration pneumonia]].<ref name="Mandell"/><ref name="Oxford"/><ref name="Harrison"/>
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| Although [[gram-negative bacilli]] are a common cause they are rarely found in the respiratory tract of people without pneumonia, which has led to speculation of the mouth and throat as origin of the infection.<ref name="Mandell"/><ref name="Oxford"/>
| | ==[[Hospital-acquired pneumonia risk factors|Risk Factors]]== |
| | | ==[[Hospital-acquired pneumonia natural history, complications, and prognosis|Natural History, Complications and Prognosis]]== |
| ==Etiology==
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| The majority of cases related to various gram-negative bacilli(52%) and [[S. aureus]] (19%). Others are [[Haemophilus]] spp. (5%). In the ICU results were S. aureus(17.4%), [[P. aeruginosa]] (17.4%), [[Klebsiella pneumoniae]] and [[Enterobacter]] spp. (18.1%), and [[Haemophilus influenzae]] (4.9%).<ref name="Mandell"/> Viruses -[[influenza]] and [[respiratory syncytial virus]] and, in the immunocompromised host, [[cytomegalovirus]]- cause 10-20% of infections.<ref name="Oxford"/>
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| ==Risk factors== | |
| Among the factors contributing to contracting HAP are [[mechanical ventilation]] ([[ventilator-associated pneumonia]]), old age, decreased filtration of inspired air, intrinsic respiratory, neurologic, or other disease states that result in respiratory tract obstruction, trauma, (abdominal) surgery, medications, diminished lung volumes, or decreased clearance of secretions may diminish the defenses of the lung. Also poor hand-washing and inaqeuate disinfection of respiratory devicescauses [[cross-infection]] and is an important factor.<ref name="Mandell"/><ref name="Harrison"/>
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| ==Clinical Features==
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| [[Image:Pneumonia_x-ray.jpg|thumb|left|175px|'''Pneumonia as seen on chest x-ray.'''
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| ''A'': Normal chest x-ray. ''B'': Abnormal chest x-ray with shadowing from pneumonia in the right lung (left side of image).]]
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| New or progressive infiltrate on the chest X-Ray with one of the following:<ref name="Harrison"/>
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| * [[Fever]] > 37.8 °C (100 °F)
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| * Purulent sputum
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| * [[Leucocytosis]] > 10.000 cells/μl
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| ==Diagnosis== | | ==Diagnosis== |
| In hospitalised patient who develop respiratory symptoms and fever one should consider the diagnosis. The likelyhood increases when upon investigation symptoms are found of [[respiratory insufficiency]], purulent secretions, newly developed infiltrate on the [[chest X-Ray]], and increasing [[leucocytosis|leucocyte count]]. If pneumonia is suspected material from sputum or tracheal aspirates are sent to the [[microbiology department]] for cultures. In case of [[pleural effusion]] [[thoracentesis]] is performed for examination of [[pleural fluid]]. In suspected ventilator-associated pneumonia it has been suggested that [[bronchoscopy]]([[BAL]]) is necessary because of the known risks surrounding clinical diagnoses.<ref name="Mandell"/><ref name="Harrison"/>
| | [[Hospital-acquired pneumonia diagnostic criteria|Diagnostic Criteria]] | [[Hospital-acquired pneumonia diagnostic algorithm|Diagnostic Algorithm]] | [[Hospital-acquired pneumonia history and symptoms| History and Symptoms]] | [[Hospital-acquired pneumonia physical examination | Physical Examination]] | [[Hospital-acquired pneumonia laboratory tests|Laboratory Findings]] | [[Hospital-acquired pneumonia chest x ray|Chest X Ray]] | [[Hospital-acquired pneumonia CT|CT]] | [[Hospital-acquired pneumonia other imaging findings|Other Imaging Findings]] |
| ===Diagnostic criteria of hospital acquired pneumonia===
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| [[Community acquired pneumonia]] should be distinguished from healthcare-associated pneumonia as these diseases have different causative organism, prognosis, diagnostic and treatment guidelines.
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| According to the Infectious Diseases Society of America and the American Thoracic Society healthcare-associated pneumonia includes any patient who meet the below criteria <ref name="pmid21663884">{{cite journal |author=Attridge RT, Frei CR |title=Health care-associated pneumonia: an evidence-based review |journal=[[The American Journal of Medicine]] |volume=124 |issue=8 |pages=689–97 |year=2011 |month=August |pmid=21663884 |doi=10.1016/j.amjmed.2011.01.023 |url=http://linkinghub.elsevier.com/retrieve/pii/S0002-9343(11)00291-9 |accessdate=2012-09-02}}</ref>
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| * Hospitalized in an acute care hospital for 2 or more days within 90 days of the infection;
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| * Resided in a nursing home or long-term care facility;
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| * Received recent intravenous antibiotic therapy, chemotherapy, or wound care within the past 30 days of the current infection;
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| * Attended a hospital or hemodialysis clinic
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| ==Differential diagnosis==
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| * [[Atelectasis]]
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| * [[Congestive heart failure]]
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| * [[Pulmonary embolism]]
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| ==Treatment== | | ==Treatment== |
| Usually initial therapy is empirical.<ref name="Harrison"/> If sufficient reason to suspect [[influenza]] one might consider [[amantadine]] or [[rimantadine]]. In case of [[legionellosis]] [[erythromicin]] or [[fluoroquinolone]].<ref name="Mandell"/>
| | [[Hospital-acquired pneumonia medical therapy|Medical Therapy]] | [[Hospital-acquired pneumonia prevention|Prevention]] | [[Hospital-acquired pneumonia cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Hospital-acquired pneumonia future or investigational therapies|Future or Investigational Therapies]] |
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| A third generation [[cephalosporin]] (ceftazidime) + [[carbapenems]] (imipenem) + beta lactam & beta lactamase inhibitors (piperacillin/tazobactum)
| | ==Case Studies== |
| ==References== | | [[Hospital-acquired pneumonia case study one|Case #1]] |
| {{reflist|2}}
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| [[Category:Diseaase]] | | [[Category:Disease]] |
| [[Category:Pulmonology]] | | [[Category:Pulmonology]] |
| [[Category:Infectious disease]]
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| [[Category:Pneumonia|Pneumonia]] | | [[Category:Pneumonia]] |
| [[Category:Emergency medicine]] | | [[Category:Emergency medicine]] |
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| {{WH}} | | {{WH}} |
| {{WS}} | | {{WS}} |