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Healthcare Associated Pneumonia (HCAP)....why is this important for the emergency physician?
Most of us are very familiar with the types of pneumonias commonly seen in clinical practice: community-acquired pneumonia (CAP), hospital-acquired pneumonia(HAP), and ventilator-associated pneumonia (VAP). But, some may not be that aware of a relatively newer type of pneumonia that has been well-defined, healthcare-associated pnemonia (HCAP). Experts in infectious disease and critical care now say that we (the ED) should be assessing ALL pneumonia patients for HCAP risk factors.
Why care, you ask?
- Higher mortality than CAP
- May look like CAP
- Treated much differently than CAP
Risk factors: (most are common sense)
- Nursing home or extended care facility resident
- Recently admiited to a hospital for 2 or more days in the preceeding 90 days
- Home wound care or attending a clinic for wound care
- Dialysis patient
- Home infusion therapy (antibiotics)
- Immunosuppresive therapy or disease
Treatment:
- 3 drugs....not like treatment of CAP!
- Usually a combination of a big gun anti-pseudomonal (e.g. Pip/Tazo) combined with a broad spectrum respiratory fluoroquinolone (e.g. Moxi), combined with Vancomycin
- Key difference between treatment of CAP and HCAP is consideration for multi-drug resistant pathogens, pseudomonas, and MRSA.