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 Pneumoniaa
MULTIDRUG-RESISTANT GRAM-NEGATIVE BACTERIA AND MRSANOSOCOMIAL MRSACOMMUNITY-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 bronchiectasisb
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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