Background: Your patient has pneumonia: she is hypoxic, tachypnoeic and pyrexial. You begin oxygen and reach for a drug chart to prescribe some antibiotics. "Hold on," your colleague says, "the lady stays in a nursing home - doesn't she need different antibiotics?" You pause, uncertain. "I don't think we're doing that any more," you reply unconvincingly. But should we? Is HCAP (healthcare-associated pneumonia) still a thing?

 

 

What is HCAP? It was introduced and defined in guidelines from the American Thoracic Society / Infectious Diseases Society of America (IDSA) in 2005​[1]​. They were concerned that the following groups of patients were at higher risk of multi-drug resistant infections and should therefore be treated with broad spectrum antibiotics...

 

Those residing in a nursing home or extended care facility

Those hospitalised for 2 or more days during the preceding 90 days

Those receiving home infusion therapy

Those receiving domiciliary wound care

Those attending a haemodialysis centre within the preceding 30 days

 

 

It is fair to say that the concept of HCAP has been controversial from the beginning. Many studies failed to replicate the higher frequency of drug-resistant pathogens in these patient groups, and many have argued that the value of the HCAP concept varies by geographical region. I'll take a look at one representative study from each of these groups below.

 

 

Paper 1: Polverino E, Torres A, Menendez R. Microbial aetiology of healthcare associated pneumonia in Spain: a prospective, multicentre, case-control study. Thorax. 2013; 68:1007-1014​[2]​

 

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