The bacterial pneumonias: a new treatment paradigm

Hosp Pract (1995). 2015;43(1):46-55. doi: 10.1080/21548331.2015.1001708. Epub 2015 Jan 6.


Pneumonia is a common disease that carries a high mortality. Traditionally, pneumonia has been classified and treated according to the setting where the pneumonia develops, namely community-acquired pneumonia, health-care-associated pneumonia, and hospital-acquired pneumonia. This classification was based on the risk of a patient being infected with a hospital-acquired drug-resistant pathogen. A new treatment paradigm has been proposed based on the risk of the patient being infected with a community-acquired drug-resistant pathogen. The risk factors for infection with a community-acquired drug-resistant pathogen include (1) hospitalization for > 2 days during the previous 90 days, (2) antibiotic use during the previous 90 days, (3) nonambulatory status, (4) tube feeds, (5) immunocompromised status, (6) use of acid-suppressive therapy, (7) chronic hemodialysis during the preceding 30 days, (8) positive methicillin-resistant Staphylococcus aureus history within the previous 90 days, and (9) present hospitalization > 2 days. This article reviews this new treatment paradigm and other issues relevant to the diagnosis and management of pneumonia based on information from MEDLINE, EMBASE, and the Cochrane Register of Controlled Trials.

Keywords: Pneumonia; community-acquired pneumonia; drug-resistant pathogen; gram-negative bacteria; health-care–associated pneumonia; hospital-associated pneumonia.

Publication types

  • Review

MeSH terms

  • Anti-Bacterial Agents / administration & dosage
  • Anti-Bacterial Agents / therapeutic use*
  • Biomarkers
  • Community-Acquired Infections / diagnosis
  • Community-Acquired Infections / drug therapy*
  • Community-Acquired Infections / microbiology
  • Cross Infection / diagnosis
  • Cross Infection / drug therapy*
  • Cross Infection / microbiology
  • Drug Resistance, Multiple, Bacterial
  • Gastrointestinal Agents / therapeutic use
  • Hospitalization / statistics & numerical data
  • Humans
  • Immunocompromised Host
  • Influenza A virus
  • Influenza, Human / epidemiology
  • Methicillin-Resistant Staphylococcus aureus
  • Pneumonia, Bacterial / diagnosis
  • Pneumonia, Bacterial / drug therapy*
  • Pneumonia, Bacterial / microbiology
  • Renal Dialysis
  • Risk Assessment
  • Risk Factors


  • Anti-Bacterial Agents
  • Biomarkers
  • Gastrointestinal Agents