CHEST Guidelines-CAP,-HCAP,-HAP, VAP

CAP,-HCAP,-HAP, VAP_chest (1)

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The article critically assesses pneumonia classifications—community-acquired (CAP), healthcare-associated (HCAP), hospital-acquired (HAP), and ventilator-associated pneumonia (VAP)—using a study of 283,927 pneumonia cases in New York City hospitals (2010-2014). CAP was the most prevalent (54.3%), while VAP, though least common (1.6%), showed the highest mortality rate (21.6%). Despite its low incidence, VAP accounts for significant death rates, similar to previous studies.<br /><br />The study brings into question the utility of the HCAP designation, initially created to manage drug-resistant infections. HCAP treatment often involves broad-spectrum antimicrobials but doesn't significantly increase drug-resistant pathogen identification. It's also a poor predictor of mortality and may contribute to resistance by encouraging broad-spectrum antibiotics.<br /><br />The current paradigm is challenged by the recent Infectious Diseases Society of America and American Thoracic Society guidelines, recommending against the use of HCAP to characterize patients from the community at risk for drug-resistant pneumonia. Rapid diagnostic tests are proposed as a more effective way for early detection and guiding treatment. These tests can potentially decrease mortality, reduce hospital stays, and lower the use of broad-spectrum drugs by providing timely pathogen identification and antimicrobial susceptibility, thus improving antimicrobial stewardship.<br /><br />The need for comprehensive data repositories of drug-resistant pathogens is emphasized to facilitate large-scale studies linking pathogen characteristics, resistance profiles, and clinical outcomes. Such data would empower the development of universally applicable diagnostic methods and treatment protocols.<br /><br />Overall, the article urges the re-evaluation of pneumonia classification systems, attention to local antimicrobial resistance patterns, and the adoption and validation of rapid diagnostics to improve patient outcomes and combat antimicrobial resistance.

Keywords

pneumonia classification

community-acquired pneumonia

healthcare-associated pneumonia

hospital-acquired pneumonia

ventilator-associated pneumonia

mortality rates

drug-resistant infections

broad-spectrum antimicrobials

rapid diagnostic tests

antimicrobial resistance