HAP and VAP combine to represent the most common cause of death among all hospital-acquired infections, with mortality rates ranging from 20% to 50%. Ventilator-associated pneumonia (VAP) manifests 48 to 72 hours after endotracheal intubation. Hospital-acquired pneumonia (HAP) is defined as pneumonia occurring 48 hours or more after a hospital admission. aureus (MRSA), Pseudomonas aeruginosa, and Acinetobacter spp. Patients with HCAP are more commonly infected with antibiotic-resistant bacteria, such as methicillin-resistant S. Health care–associated pneumonia (HCAP) occurs in patients who have recently been hospitalized for 2 or more days in the 90 days preceding infection resided in a nursing home or other long-term–care facility or received recent intravenous antibiotic therapy, chemotherapy, hemodialysis, or wound care within the 30 days preceding infection. Among the atypical infections are Legionella spp., Mycoplasma pneumoniae, and Chlamydia pneumoniae. Typical organisms causing CAP include Streptococcus pneumoniae, Haemophilus influenzae, Staphylococcus aureus, group A streptococci, Moraxella catarrhalis, anaerobes, and aerobic gram-negative bacteria. However, given its widespread use in clinical practice, the grouping of typical and atypical causes of pneumonia has persisted. With patients surviving longer, this atypical presentation is now seen with both the traditional atypical organisms as well as other infectious agents, making the distinction imprecise and anachronistic. In addition, atypical pneumonia often is associated with more systemic manifestations of disease, including gastrointestinal abnormalities, hepatitis, and meningoencephalitis. This form was termed atypical, and the causative agents were termed atypical infections. In the late 1930s a separate clinical course was described for pneumonia with a longer more indolent onset that progressed to the more typical clinical presentation. Pneumococcus remains the most common bacterial pathogen responsible for CAP, although its incidence has declined with the widespread use of the pneumococcal vaccination and with decreased rates of cigarette smoking. Incidence in the general population is approximately 5 to person years, with about 5.6 million cases of CAP encountered per year, representing one of the most commonly treated infectious diseases. Multidrug-resistant (MDR) bacteria are more commonly encountered in hospital or health care–associated pneumonia.Ĭommunity-acquired pneumonia (CAP) manifests in a patient who has not been recently hospitalized and who has had no regular exposure to the health care system. Pneumonia is broadly divided into infection acquired in the community versus acquired in health care settings, including hospitals and nursing homes. Although pneumonia affects all ages, increased morbidity and mortality are seen at the extremes of age (very young and very old). Pneumonia and influenza represent the eighth leading cause of mortality in the United States, with an estimated 1.3 million hospital admissions yearly attributable to pneumonia in patients older than 65 years.
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