What is Hospital-Acquired Pneumonia (HAP)?

From the Guidelines

Hospital-acquired pneumonia (HAP) is defined as pneumonia that occurs 48 hours or more after admission, which was not incubating at the time of admission. This definition is crucial in identifying and managing HAP, as it allows healthcare providers to distinguish between community-acquired and hospital-acquired infections 1.

Key Characteristics of HAP

• HAP may be managed in a hospital ward or in the intensive care unit (ICU) when the illness is more severe 1
• HAP is a significant cause of morbidity and mortality, despite advances in antimicrobial therapy and supportive care 1
• The management of HAP involves avoiding untreated or inadequately treated infections, recognizing the variability of bacteriology, avoiding the overuse of antibiotics, and applying prevention strategies 1

Management and Prevention of HAP

• The initial evaluation and management of HAP should focus on the immunocompetent, adult patient with bacterial causes of HAP 1
• Recommendations to reduce the risk of pneumonia are limited to key, modifiable risk factors related to the pathogenesis of pneumonia 1
• Prevention strategies include good hand hygiene, early mobilization of patients, and minimizing the duration of mechanical ventilation when applicable 1
• The goal of management is to provide a framework for the initial evaluation and management of HAP, and to prevent the overuse of antibiotics 1

Importance of Accurate Diagnosis and Treatment

• Accurate diagnosis and treatment of HAP are crucial to prevent increased mortality and morbidity 1
• The use of broad-spectrum antibiotics should be guided by the expected antimicrobial susceptibility of the common bacterial pathogens 1
• Therapeutic algorithms should be based on the results of lower respiratory tract cultures, and the duration of therapy should be shortened to the minimal effective period 1

From the Research

Definition and Overview of Hospital-Acquired Pneumonia (HAP)

• Hospital-acquired pneumonia (HAP) is a leading cause of death, morbidity, and resource utilization in hospitalized patients 2.
• HAP is associated with a broad range of Gram-positive and Gram-negative pathogens 2.
• It is a form of nosocomial pneumonia, distinct from ventilator-associated pneumonia (VAP) 3.

Risk Factors and Treatment Considerations

• The therapeutic approach to HAP must be patient-oriented and institution-specific, taking into account specific risk factors such as previous antibiotic exposure, underlying diseases, length of hospital stay, and local patterns of antimicrobial resistance 4.
• Initial antimicrobial treatment must be appropriate and given as soon as possible, as inappropriate or delayed therapy can greatly increase morbidity and mortality 2.
• Selection of the most appropriate antimicrobial agent depends on the causative pathogen(s), and initial broad-spectrum therapy is commonly recommended to cover all potential pathogens 2.

Treatment Options and Guidelines

• Guidelines consistently emphasize the importance of treating HAP with early and appropriate broad-spectrum antibiotics 2.
• New antibiotic treatments, such as telavancin and ceftobiprole, have been approved for the treatment of HAP and offer effective alternative therapeutic options 2, 5.
• Recent studies support the idea that not all HAP patients need antipseudomonal therapy, and an approach that provides appropriate therapy without the overuse of broad-spectrum therapy is possible 3.