Hospital Acquired Pneumonia

Course Credit: 1 hour

With multidrug-resistant (MDR) pathogens increasing and a dwindling pipeline of new antibiotics to treat these pathogens, sensible use of antibiotics is needed. ED clinicians have an opportunity to optimize treatment for patients with pneumonia who are at risk for MDR pathogens.Recently, the Infectious Diseases Society of America (IDSA) published a much-needed update to the Hospital Acquired Pneumonia / Ventilator Associated Pneumonia (HAP/VAP) guidelines. While the Infectious Diseases Society of America (IDSA) guidelines recognize that there are no standardized definitions for HAP and VAP, they are loosely defined.

• HAP is characterized as pneumonia not incubated at the time of hospital admission and occurring 48 hours or more after admission.
• VAP is pneumonia occurring >48 hours after endotracheal intubation.

Using these interpretations, HAP and VAP are not commonly seen in the ED; however, treatment and risk factors are similar to patients commonly presenting with pneumonia. Both HAP and VAP patients have similar outcomes and infectious pathogens, and therefore receive comparable empiric antibiotics. VAP will not be discussed due to the low likelihood of encounters in the ED.

Learning Objectives

1. Identify common organisms that cause hospital-acquired pneumonia (HAP)
2. Explain why healthcare-associated pneumonia (HCAP) was removed from the 2016 IDSA guidelines
3. Recognize risk factors for multidrug-resistant organisms for HAP
4. Describe antibiotic treatment options for HAP in the ED