Ask the Expert: Dr. Bedimo on HCAP

You are on call and get a call from the ER for possible pneumonia in a patient that resides in a nursing home. How do you approach the choice of antibiotic therapy? Should this be treated as community-acquired pneumonia, or health-care associated pneumonia?

Dr. Bedimo, Chief of the Infectious Disease Division at the North Texas VA Medical Center, notes the following: “The ATS/IDSA guidelines indeed include nursing homes in the definition of Health Care Associated Pneumonia (Am J Respir Crit Care Med. 2005;171(4):388).

Healthcare-associated pneumonia (HCAP) is defined as pneumonia that occurs in a non-hospitalized patient with extensive healthcare contact, as defined by one or more of the following:

  • Intravenous therapy, wound care, or intravenous chemotherapy within the prior 30 days
  • Residence in a nursing home or other long-term care facility
  • Hospitalization in an acute care hospital for two or more days within the prior 90 days
  • Attendance at a hospital or hemodialysis clinic within the prior 30 days

However, the issue is whether these settings indeed increase the likelihood of multi-drug resistant pathogens such as MRSA and MDR Pseudomonas.  The above guidelines are dated, and there’s recent controversy over the topic.  So, newer guidelines (due anytime now) might change to likely exclude nursing home residents without recent hospital contact…”