Healthcare-associated Pneumonia

In medicine, healthcare-associated pneumonia (HCAP) is a category of pneumonia in patients with recent close contact with the health care system.

HCAP is a condition in patients who are not hospitalised (similar to community-acquired pneumonia, CAP) but its causes, prognosis, prevention and treatment are more similar to hospital-acquired pneumonia (HAP). The category was introduced because healthcare has increasingly shifted from hospital-based to home care, and more people are residing in nursing homes or extended care facilities.

Nursing home-acquired pneumonia is an important subgroup of HCAP. Residents of long term care facilities may become infected through their contacts with the healthcare system; as such, the microbes responsible for their pneumonias may be different from those traditionally seen in community-dwelling patients, requiring therapy with different antibiotics. Other groups include patients who are admitted as a day case for regular hemodialysis or intravenous infusion (for example, chemotherapy). Especially in the very old and in demented patients, HCAP is likely to present with atypical symptoms.

Compared to subjects with CAP, the pneumonia in HCAP is more likely to be caused by bacteria resistant to first line antibiotics, such as methicillin-resistant Staphylococcus aureus (MRSA) or Pseudomonas aeruginosa. The optimal antibiotic strategy for the treatment of HCAP remains controversial. Influenza vaccines have been shown to reduce the risk of pneumonia in nursing home residents. The pneumococcal polysaccharide vaccine is also recommended, although the evidence for its preventative role against pneumonia is more conflicting.

HCAP was first suggested as a novel category of pneumonia in 2005 by the American Thoracic Society and Infectious Diseases Society of America.