Health care–associated pneumonia: Meeting the clinical challenges
نویسنده
چکیده
The risk factors for health care–associated pneumonia (HCAP) include hospitalization for 2 or more days within the past 90 days, residence in a nursing home or extended-care facility, home infusion therapy, and long-term dialysis within the past 30 days. Distinguishing between community-acquired pneumonia (CAP) and HCAP is important because of the implications for therapy. Compared with CAP, HCAP is more likely to be caused by multidrug-resistant organisms and is associated with a higher mortality rate. The management of HCAP requires antimicrobial coverage of Pseudomonas aeruginosa, Acinetobacter species, extended-spectrum ß-lactamase– producing Enterobacteriaceae, and methicillin-resistant Staphylococcus aureus. Empirical narrowing of therapy is probably safe in patients with culture-negative HCAP who have improved with broad-spectrum therapy. (J Respir Dis. 2008;29(5): 208-213)
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