The Role of Gram-Negative Bacteria in Healthcare-Associated Pneumonia

ABSTRACT

Healthcare-associated pneumonia (HCAP) is a unique entity that differs from community-acquired pneumonia in both bacteriology and outcomes and has similarities to hospital-acquired pneumonia and ventilator-associated pneumonia. HCAP patients are at higher risk of potential multidrug-resistant pathogens, including resistant gram-negative organisms, especially Pseudomonas aeruginosa and Acinetobacter spp., but also extended-spectrum β-lactamases (ESBLs). This manuscript reviews the epidemiology, etiology, and clinical outcomes of hospitalized HCAP patients due to gram-negative bacteria. We will focus our attention on the potential multidrug-resistant pathogens to suggest a new treatment approach for these patients.

KEYWORDS

Pneumonia - healthcare-associated - outcomes

REFERENCES

• 1 Mandell L A, Wunderink R G, Anzueto A et al.. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults.  Clin Infect Dis. 2007;  44 S27-S72
• 2 American Thoracic Society/Infectious Diseases Society of America . Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia.  Am J Respir Crit Care Med. 2005;  171 388-416
• 3 Friedman N D, Kaye K S, Stout J E et al.. Health care-associated bloodstream infections in adults: a reason to change the accepted definition of community-acquired infections.  Ann Intern Med. 2002;  137 791-797
• 4 Muder R R, Aghababian R V, Loeb M B et al.. Nursing home-acquired pneumonia: an emergency department treatment algorithm.  Curr Med Res Opin. 2004;  20 1309-1320
• 5 Pop-Vicas A E, D'Agata E M. The rising influx of multidrug-resistant gram-negative bacilli into a tertiary care hospital.  Clin Infect Dis. 2005;  40 1792-1798
• 6 Naimi T S, LeDell K H, Como-Sabetti K et al.. Comparison of community- and health care-associated methicillin-resistant Staphylococcus aureus infection.  JAMA. 2003;  290 2976-2984
• 7 Tambyah P A, Habib A G, Ng T M et al.. Community-acquired methicillin-resistant Staphylococcus aureus infection in Singapore is usually “healthcare associated”.  Infect Control Hosp Epidemiol. 2003;  24 436-438
• 8 Engelhart S T, Hanses-Derendorf L, Exner M et al.. Prospective surveillance for healthcare-associated infections in German nursing home residents.  J Hosp Infect. 2005;  60 46-50
• 9 Lesens O, Hansmann Y, Brannigan E et al.. Healthcare-associated Staphylococcus aureus bacteremia and the risk for methicillin resistance: is the Centers for Disease Control and Prevention definition for community-acquired bacteremia still appropriate?.  Infect Control Hosp Epidemiol. 2005;  26 204-209
• 10 McDonald J R, Friedman N D, Stout J E et al.. Risk factors for ineffective therapy in patients with bloodstream infection.  Arch Intern Med. 2005;  165 308-313
• 11 Morin C A, Hadler J L. Population-based incidence and characteristics of community-onset Staphylococcus aureus infections with bacteremia in 4 metropolitan Connecticut areas, 1998.  J Infect Dis. 2001;  184 1029-1034
• 12 Shorr A F, Linde-Zwirble W T, Angus D C. No longer the “expensive scare unit”?.  Crit Care Med. 2004;  32 1408-1409
• 13 Siegman-Igra Y, Fourer B, Orni-Wasserlauf R et al.. Reappraisal of community-acquired bacteremia: a proposal of a new classification for the spectrum of acquisition of bacteremia.  Clin Infect Dis. 2002;  34 1431-1439
• 14 Hutt E, Kramer A M. Evidence-based guidelines for management of nursing home-acquired pneumonia.  J Fam Pract. 2002;  51 709-716
• 15 Mylotte J M. Nursing home-acquired pneumonia.  Clin Infect Dis. 2002;  35 1205-1211
• 16 Tablan O C, Anderson L J, Besser R et al.. Guidelines for preventing health-care–associated pneumonia, 2003: recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee.  MMWR Recomm Rep. 2004;  53 1-36
• 17 Kollef M H, Shorr A, Tabak Y P et al.. Epidemiology and outcomes of health-care-associated pneumonia: results from a large us database of culture-positive pneumonia.  Chest. 2005;  128 3854-3862
• 18 Guest J F, Morris A. Community-acquired pneumonia: the annual cost to the National Health Service in the UK.  Eur Respir J. 1997;  10 1530-1534
• 19 Marrie T J. Community-acquired pneumonia.  Clin Infect Dis. 1994;  18 501-513 , quiz 514–505
• 20 Kollef M H, Morrow L E, Baughman R P et al.. Healthcare-associated pneumonia (HCAP): a critical appraisal to improve identification, management, and outcomes–proceedings of the HCAP Summit.  Clin Infect Dis. 2008;  46(Suppl 4) S296-S334 , quiz 335–298
• 21 Carratala J, Mykietiuk A, Fernandez-Sabe N et al.. Healthcare-associated pneumonia requiring hospital admission: epidemiology, antibiotic therapy, and clinical outcomes.  Arch Intern Med. 2007;  167 1393-1399
• 22 Micek S T, Kollef K E, Reichley R M et al.. Healthcare-associated pneumonia and community-acquired pneumonia: a single-center experience.  Antimicrob Agents Chemother. 2007;  51 3568-3573
• 23 Medina-Walpole A M, Katz P R. Nursing home-acquired pneumonia.  J Am Geriatr Soc. 1999;  47 1005-1015
• 24 Muder R R. Pneumonia in residents of long-term care facilities: epidemiology, etiology, management, and prevention.  Am J Med. 1998;  105 319-330
• 25 Vergis E N, Brennen C, Wagener M et al.. Pneumonia in long-term care: a prospective case-control study of risk factors and impact on survival.  Arch Intern Med. 2001;  161 2378-2381
• 26 El-Solh A A, Sikka P, Ramadan F et al.. Etiology of severe pneumonia in the very elderly.  Am J Respir Crit Care Med. 2001;  163 645-651
• 27 El Solh A A, Pietrantoni C, Bhat A et al.. Indicators of potentially drug-resistant bacteria in severe nursing home-acquired pneumonia.  Clin Infect Dis. 2004;  39 474-480
• 28 Leibovitz A, Dan M, Zinger J et al.. Pseudomonas aeruginosa and the oropharyngeal ecosystem of tube-fed patients.  Emerg Infect Dis. 2003;  9 956-959