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

CAP,-HCAP,-HAP, VAP_chest

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In the article from CHEST, Jason P. Burnham, MD, and Marin H. Kollef, MD, discuss the epidemiology and classification of pneumonia, based on a study by Corrado et al. in New York City from 2010 to 2014, which analyzed 283,927 pneumonia cases. The types of pneumonia include community-acquired (CAP), healthcare-associated (HCAP), hospital-acquired (HAP), and ventilator-associated pneumonia (VAP). CAP is the most common at 54.3%, while VAP, although least common at 1.6%, leads to the highest in-hospital mortality rate (21.6%). The study concludes that HCAP, HAP, and VAP-related hospitalizations have higher mortality rates than CAP.<br /><br />Notably, HCAP, though less common than CAP, accounted for more deaths. This underscores the challenge posed by drug-resistant infections, a primary concern originally targeted by the HCAP classification. However, recent guidelines recommend discontinuing the use of the HCAP term, creating a gap in guidance for handling potentially drug-resistant pneumonias.<br /><br />Burnham and Kollef discuss how the overuse of broad-spectrum antimicrobials, due to adherence to HCAP guidelines, has not led to an increased isolation of drug-resistant organisms but may contribute to the rise of such pathogens. They argue that rapid diagnostic tests offer a promising solution for identifying drug-resistant infections swiftly, allowing for timely and appropriate antimicrobial intervention.<br /><br />Rapid diagnostic tools, like the Accelerate Pheno system and Xpert Carba-R assay, can enhance patient care by enabling quicker antimicrobial susceptibility testing. Implementing these tests, alongside workforce education and considering local antibiograms, can improve treatment outcomes and reduce healthcare costs.<br /><br />The authors advocate for establishing national and international data repositories on clinical pathogens to examine the impact of drug-resistant infections more comprehensively. This information is crucial for developing effective treatment strategies and achieving better clinical outcomes. The study highlights the need for improved classification systems and rapid diagnostic tests in managing pneumonia effectively.

Keywords

pneumonia

epidemiology

classification

drug-resistant infections

rapid diagnostic tests

healthcare-associated pneumonia

community-acquired pneumonia

hospital-acquired pneumonia

ventilator-associated pneumonia

antimicrobial intervention