Healthcare-associated pneumonia is a heterogeneous disease, and all patients do not need the same broad-spectrum antibiotic therapy as complex nosocomial pneumonia

Curr Opin Infect Dis. 2009 Jun;22(3):316-25. doi: 10.1097/QCO.0b013e328329fa4e.


Purpose of review: Healthcare-associated pneumonia (HCAP) develops in patients who have recently had contact with nosocomial and drug-resistant pathogens, because of a history of hospitalization in the past 90 days, need for hemodialysis or home wound care, or residence in a nursing home. HCAP was included in the 2005 American Thoracic Society/Infectious Diseases Society of America guidelines for nosocomial pneumonia, with the recommendation that all such patients receive empiric therapy with a multidrug regimen directed against drug-resistant organisms. The purpose of this review was to examine articles published since the guidelines were developed to see whether this therapy recommendation is correct.

Methods: All articles published since July 2004 were identified using PubMed and the key words HCAP, nursing home-acquired pneumonia, and antibiotic therapy. The search was limited to adults, with a focus on clinical trials, reviews, meta-analyses, or practice guidelines.

Recent findings: We identified eight unique studies of HCAP, which were either prospective or retrospective series, with bacteriologic data on both Gram-negative and Gram-positive organisms. We also examined three prospective, randomized therapy trials of nursing home-acquired pneumonia that included limited bacteriologic data. We found that patients with HCAP were a heterogeneous group, with some at risk for multidrug-resistant organisms, and others not, and this accounted for the observation that many patients were successfully treated with monotherapy regimens or with regimens used for patients with community-acquired pneumonia. Patients at risk for multidrug-resistant pathogens were those with severe illness or those with other risk factors including: hospitalization in the past 90 days, antibiotic therapy in the past 6 months, poor functional status as defined by activities of daily living score, and immune suppression.

Conclusion: On the basis of the risk factors identified in recent studies, we developed an algorithm for empiric therapy of HCAP, which suggests that not all such patients require a broad-spectrum multidrug regimen in order to achieve appropriate and effective therapy. This algorithm needs validation in future studies.

Publication types

  • Review

MeSH terms

  • Adult
  • Anti-Bacterial Agents / therapeutic use*
  • Clinical Trials as Topic
  • Cross Infection / drug therapy*
  • Drug Resistance, Bacterial
  • Humans
  • Pneumonia / drug therapy*
  • United States


  • Anti-Bacterial Agents