From the Guidelines
Hospital-Acquired Pneumonia (HAP) is an infection of the pulmonary parenchyma caused by pathogens present in hospital settings.
Definition and Epidemiology
- HAP is defined as pneumonia that develops in patients admitted to the hospital for more than 48 hours, with an incubation period of at least 2 days 1.
- The incidence of HAP ranges from 5 to more than 20 cases per 1000 hospital admissions, with the highest rates in immunocompromised, surgical, and elderly patients 1.
- HAP is the second most common nosocomial infection and the leading cause of death from nosocomial infections in critically ill patients 1.
Types of HAP
- Ventilator-Associated Pneumonia (VAP): develops in ICU patients who have been mechanically ventilated for at least 48 hours 1.
- Non-Ventilator HAP: occurs in patients admitted to the hospital for at least 48 hours, without mechanical ventilation 1.
Clinical Impact
- HAP and VAP increase duration of hospitalization and healthcare costs, with a mean attributable cost of VAP estimated to be approximately $40,000 per patient 1.
- HAP is associated with an approximate mortality rate of 20% in the ICU, with an estimated attributable mortality of 5-13% 1.
- HAP is also responsible for increased morbidity, including increased duration of mechanical ventilation, ICU and hospital length-of-stay, and overuse of healthcare resources 1.
From the Research
Definition and Overview of Hospital-Acquired Pneumonia (HAP)
- Hospital-acquired pneumonia (HAP) is a type of nosocomial infection that occurs in hospitalized patients, with mortality rates approaching 62% 2.
- HAP is the second most common cause of nosocomial infection overall, but is the most common cause documented in the intensive care unit setting 2.
- HAP and its subtype, ventilator-associated pneumonia (VAP), remain significant causes of morbidity and mortality worldwide 3.
Causes and Risk Factors of HAP
- HAP can be caused by various pathogens, including antibiotic-resistant bacteria, and is associated with excess mortality and increased medical care costs 4.
- The risk factors for HAP include the need for mechanical ventilation, with VAP being the most common nosocomial infection among patients with acute respiratory failure 4.
- Prior detection of risk factors, combined with clear clinical judgment based on clinical scores and inflammatory biomarkers, is crucial for a well-established management plan 3.
Diagnosis, Management, and Prevention of HAP
- The diagnosis of HAP can be challenging, especially in the intensive care unit, due to the complexity of critically ill patients 5.
- The management of HAP involves antimicrobial treatment, nonantimicrobial management, and prevention strategies, including the use of evidence-based guidelines and bundle of care principles 2, 3.
- Prevention and risk-reduction strategies, such as clinical strategies aimed at preventing HAP and VAP, should be employed in all hospital settings caring for patients at risk for these infections 4.