PNEUMONIA

Pneumonia, an infection of the lung parenchyma, is classified as community-acquired (CAP), hospital-acquired (HAP), ventilator-associated (VAP), or health care–associated (HCAP). Although the HCAP category initially referred to CAP caused by a multidrug-resistant (MDR) pathogen, it now describes pts with at least two or three risk factors for infection with MDR pathogens (Table 134-1).

TABLE 134-1: Risk Factors for Pathogens Resistant to Usual Therapy for Community-Acquired Pneumonia^a
MULTIDRUG-RESISTANT GRAM-NEGATIVE BACTERIA AND MRSA	NOSOCOMIAL MRSA	COMMUNITY-ACQUIRED MRSA
Hospitalization ≥2 days in previous 90 days Use of antibiotics in previous 90 days Immunosuppression Nonambulatory status Tube feedings Gastric acid suppression Severe COPD or bronchiectasis^b	Hospitalization ≥2 days in previous 90 days Use of antibiotics in previous 90 days Chronic hemodialysis in previous 30 days Documented prior MRSA colonization Congestive heart failure Gastric acid suppression	Cavitary infiltrate or necrosis Gross hemoptysis Neutropenia Erythematous rash Concurrent influenza Young, previously healthy status Summer-month onset

^aCephalosporin/macrolide or respiratory fluoroquinolone.

^bRisk for Pseudomonas aeruginosa infection.

Abbreviations: COPD, chronic obstructive pulmonary disease; MRSA, methicillin-resistant Staphylococcus aureus.

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