Harrison's Manual of Medicine
PNEUMONIA
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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).
| 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 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 |
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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).
| 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 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 |
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