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In medicine, healthcare-associated pneumonia (HCAP) is a novel category of pneumonia in patients with recent close contact with the health care system.

HCAP lies between the traditional community acquired pneumonia (CAP) and hospital acquired pneumonia (HAP) (and its subcategory of ventilator-associated pneumonia). The category was introduced because healthcare has increasingly shifted from hospital-based to home care, and more people are residing in nursing homes or extended care facilities. They may become infected through their contacts with the healthcare system; as such, the microbes responsible for their pneumonias may be different from those traditionally seen in community-dwelling patients, requiring different antibiotic therapy.

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[edit] Definition

Healthcare-associated pneumonia can be defined as pneumonia in a patient with at least one of the following risk factors:

  • hospitalization in an acute care hospital for two or more days in the last 90 days;
  • residence in a nursing home or long-term care facility in the last 90 days
  • receiving outpatient infusion therapy (like antibiotics or chemotherapy) within the past 30 days
  • receiving home wound care within the past 30 days
  • attending a hospital clinic or dialysis center in the last 30 days
  • having a family member with known multi-drug resistant pathogens

Although patients with HCAP may have more severe disease than those with classic CAP, disease severity does not determine if a patient has HCAP or not; the label HCAP is merely an indicator of risk factors for multi-drug resistant bacteria.

[edit] Epidemiology

Several studies found that healthcare-associated pneumonia is the second most common type of pneumonia, occurring less commonly than community-acquired pneumonia but more frequently than hospital-acquired pneumonia and ventilator-associated pneumonia. Patients with HCAP are older and more commonly have simultaneous health problems (such as previous stroke).

The bacteria found in patients with HCAP are more similar to HAP than to CAP; compared to CAP, they have higher rates of methycillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa, and less Streptococcus pneumonia and Haemophilus influenzae. It is well known that nursing home residents have high rates of colonization with MRSA. Pneumonia caused by aspiration is probably an important cause of HCAP.

[edit] Prognosis

Healthcare-associated pneumonia seems to have fatality rates similar to hospital-acquired pneumonia, worse than community-acquired pneumonia but less severe than pneumonia in ventilated patients.

[edit] Treatment

Patients with HCAP are more likely than those with community-acquired pneumonia to receive inappropriate antibiotics that do not target the bacteria causing their disease.

In 2005, the American Thoracic Society and Infectious Diseases Society of America have published guidelines suggesting antibiotics sspecifically for HCAP.