Healthcare-associated pneumonia: is there any reason to continue to utilize this label in 2019?
Aged
Aged, 80 and over
Bacterial Infections
/ epidemiology
Clinical Decision Rules
Disease Management
Drug Resistance, Multiple, Bacterial
Enterobacteriaceae
/ classification
Female
Healthcare-Associated Pneumonia
/ diagnosis
Humans
Incidence
Male
Pseudomonas aeruginosa
/ drug effects
Staphylococcus aureus
/ drug effects
United States
Antimicrobial treatment
Multiresistance
Pneumonia
Preditive rules
Treatment failure
Journal
Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases
ISSN: 1469-0691
Titre abrégé: Clin Microbiol Infect
Pays: England
ID NLM: 9516420
Informations de publication
Date de publication:
Oct 2019
Oct 2019
Historique:
received:
04
11
2018
revised:
14
02
2019
accepted:
18
02
2019
pubmed:
3
3
2019
medline:
9
1
2020
entrez:
3
3
2019
Statut:
ppublish
Résumé
There is an ongoing controversy on the role of the healthcare-associated pneumonia (HCAP) label in the treatment of patients with pneumonia. To provide an update of the literature on patients meeting criteria for HCAP between 2014 and 2018. The review is based on a systematic literature search using PubMed-Central full-text archive of biomedical and life sciences literature at the U.S. National Institutes of Health's National Library of Medicine (NIH/NLM). Studies compared clinical characteristics of patients with HCAP and community-acquired pneumonia (CAP). HCAP patients were older and had a higher comorbidity. Mortality rates in HCAP varied from 5% to 33%, but seemed lower than those cited in the initial reports. Criteria behind the HCAP classification differed considerably within populations. Microbial patterns differed in that there was a higher incidence of methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa, and, to a lesser extent, enterobacteriaceae. Definitions and rates of multidrug-resistant (MDR) pneumonia also varied considerably. Broad-spectrum guideline-concordant treatment did not reduce mortality in four observational studies. The HCAP criteria performed poorly as a predictive tool to identify MDR pneumonia or pathogens not covered by treatment for CAP. A new score (Drug Resistance in Pneumonia, DRIP) outperformed HCAP in the prediction of MDR pathogens. Comorbidity and functional status, but not different microbial patterns, seem to account for increased mortality. HCAP should no longer be used to identify patients at risk of MDR pathogens. The use of validated predictive scores along with implementation of de-escalation strategies and careful individual assessment of comorbidity and functional status seem superior strategies for clinical management.
Sections du résumé
BACKGROUND
BACKGROUND
There is an ongoing controversy on the role of the healthcare-associated pneumonia (HCAP) label in the treatment of patients with pneumonia.
OBJECTIVE
OBJECTIVE
To provide an update of the literature on patients meeting criteria for HCAP between 2014 and 2018.
SOURCES
METHODS
The review is based on a systematic literature search using PubMed-Central full-text archive of biomedical and life sciences literature at the U.S. National Institutes of Health's National Library of Medicine (NIH/NLM).
CONTENT
BACKGROUND
Studies compared clinical characteristics of patients with HCAP and community-acquired pneumonia (CAP). HCAP patients were older and had a higher comorbidity. Mortality rates in HCAP varied from 5% to 33%, but seemed lower than those cited in the initial reports. Criteria behind the HCAP classification differed considerably within populations. Microbial patterns differed in that there was a higher incidence of methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa, and, to a lesser extent, enterobacteriaceae. Definitions and rates of multidrug-resistant (MDR) pneumonia also varied considerably. Broad-spectrum guideline-concordant treatment did not reduce mortality in four observational studies. The HCAP criteria performed poorly as a predictive tool to identify MDR pneumonia or pathogens not covered by treatment for CAP. A new score (Drug Resistance in Pneumonia, DRIP) outperformed HCAP in the prediction of MDR pathogens. Comorbidity and functional status, but not different microbial patterns, seem to account for increased mortality.
IMPLICATIONS
CONCLUSIONS
HCAP should no longer be used to identify patients at risk of MDR pathogens. The use of validated predictive scores along with implementation of de-escalation strategies and careful individual assessment of comorbidity and functional status seem superior strategies for clinical management.
Identifiants
pubmed: 30825674
pii: S1198-743X(19)30090-4
doi: 10.1016/j.cmi.2019.02.022
pii:
doi:
Types de publication
Journal Article
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
1173-1179Informations de copyright
Copyright © 2019. Published by Elsevier Ltd.