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Chapter 22. Hospital-Acquired and Ventilator-Associated Pneumonia

Ronald F Grossman, MD, FCCP
DOI: 10.1378/pulm.26.22
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Sections

Objectives 
  • Identify the key respiratory pathogens causing hospital-acquired pneumonia/ventilator-associated pneumonia.

  • Develop a systematic approach to the diagnosis of hospital-acquired pneumonia/ventilator-associated pneumonia.

  • Improve the initial therapeutic choices for the management of hospital-acquired pneumonia/ventilator-associated pneumonia.

Synopsis 

Hospital-acquired pneumonia, ventilator-associated pneumonia, and health-care-associated pneumonia (HCAP) are common hospital infections associated with significant morbidity and mortality. The concept of HCAP is not universally accepted as being useful. The most common pathogens are Staphylococcus aureus and enteric gram-negative organisms. The diagnosis is usually suspected clinically based on fever, purulent tracheobronchial secretions, elevated white blood cell count, and an abnormal chest radiograph. Pneumonia follows the aspiration of oropharyngeal contents into the lung. This is usually preceded by colonization of the oropharynx by pathogenic hospital-associated organisms. There is considerable controversy regarding the need for invasive procedures to confirm the diagnosis. Broad-spectrum coverage is usually recommended, as most studies have indicated that inadequate initial therapy is one of the most powerful predictors of a poor outcome. Once a pathogen has been defined, step-down to a more limited spectrum of antibiotic(s) has been recommended. There are many measures that have been identified that can reduce the incidence of pneumonia, and many have been bundled into discrete processes of care. These bundles do reduce pneumonia incidence but have not been shown to reduce mortality.

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