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Healthcare-Associated Pneumonia in the Intensive Care Unit

Marin H Kollef, MD1

Pneumonia is one of the most common diagnoses requiring admission to the intensive care unit (ICU). Unfortunately, the classification of pneumonia is become increasingly complex as the types of patients who develop this infection are becoming more diverse. Greater numbers of patients are being admitted to the ICU with pneumonia attributable to multidrug-resistant (MDR) bacteria, originating both within the hospital setting and outside of the hospital. Patients admitted from the community with pneumonia attributable to MDR bacteria can no longer be simply classified as having community-acquired pneumonia (CAP). These patients often have distinct risk factors including long-term residence in non-hospital healthcare facilities (e.g. nursing homes, assisted-living environments, or rehabilitation facilities), having undergone outpatient procedures or therapies (haemodialysis, wound care, or infusion therapy), recent discharge from an acute-care hospital, and significant underlying immunosuppression. Patients with such risk factors presenting to the hospital with pneumonia are now classified as having healthcare-associated pneumonia (HCAP). HCAP differs from CAP with respect to pathogens and prognosis, and, in fact, more closely resembles hospital-acquired pneumonia and ventilator-associated pneumonia. Patients with HCAP require broader initial empirical antimicrobial therapy to ensure that appropriate treatment is administered. Adv Anaesthesiol Crit Care 2009;1(2):45–51.

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