Healthcare-Associated

Pneumonia (HCAP)

HCAP: Defining the Problem

Healthcare-associated pneumonia
(HCAP) is an emerging pneumonia
category
There is increasing recognition that
individuals who acquire infections
while receiving out-of-hospital
healthcare differ from those with
community-acquired infections.

HCAP: Defining the Problem

HCAP includes patients with healthcaresystem contact in the days and/or weeks
prior to infection.
Multiple studies suggest that HCAP differs
from community-acquired pneumonia
(CAP) in terms of demographics, risk
factors, and disease characteristics.
All patients with HCAP are considered at
risk for multi-drug resistant (MDR) and
atypical organisms

Differentiating Pneumonia
Types
Pneumonia is the third leading cause of death
among the Filipino people based on the Philippine
health statistics in DOH.

HCAP: Guideline Definition

Pneumonia is considered healthcare associated in
individuals meeting any one of the following
conditions:
Any patient who was hospitalized in an acute
care hospital for two or more days within 90
days of the infection
Resided in nursing home or long-term care
facility
Received recent IV antibiotic therapy,
chemotherapy or wound care within the past
30 days of the current infection;
Attended a hospital or hemodialysis clinic
All patients meeting these criteria should also be

Bacterial Etiology

Pseudomonas Aeruginosa
Escherichia coli
Klebsiela pneumoniae
Enterobacter spp.
Serratia spp.
Acinetobacter
Methicillin resistant Staphylococcus Aureus
Streptococcus Pneumoniae
Heamophilus Influenzae
Legionella pneumophila

Fungal Etiology
Candida spp.
Aspergillus spp.

Viral Etiology

Influenza
Parainfluenza
Adenovirus
Measles
Respiratory syncytial virus

Diagnostic Strategies
Suspicion of pneumonia
Clinical findings: fever, purulent sputum,
leukocytosis
Radiographic infiltrate
Decline in arterial oxygenation
saturation
Other signs: hemodynamic instability,
deterioration of blood gases

Distinguish HCAP from CAP by history

Assessing Response to
Therapy
Clinical improvement usually takes
4872 hours, and thus therapy
should not be changed during this
time unless there is rapid clinical
decline.
Nonresponse to therapy is usually
evident by Day 3, using an
assessment of clinical parameters.

Duration of Therapy
Efforts should be made to shorten
the duration of therapy from the
traditional 14 to 21 days to periods
as short as 7 days, provided that the
etiologic pathogen is not P.
aeruginosa, and that the patient has
a good clinical response with
resolution of clinical features of
infection.