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Health Dictionary

Reliable, easy-to-read patient information on common medical conditions — written in plain language, free of jargon, and grounded in current evidence. Browse the most frequent diagnoses, understand what they mean for everyday life, and learn which steps and questions help you have a focused conversation with your doctor.

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Hospital-acquired pneumonia diagnostic algorithm

Introduction

Diagnostic Algorithm

Diagnostic Algorithm

Shown below is an algorithm for the diagnostic approach of Healthcare-associated pneumonia (HCAP), Ventilator-associated pneumonia VAP), and Hospital-acquired pneumonia (HAP).[1]

 
 
 
 
 
 
High suspicion of HAP, VAP or HCAP
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Obtain sputum or respiratory secretions sample for culture and microscopy
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Does the patient has any of the following risk factors for MDR infection?
  • Antimicrobial therapy in preceding 90 days
  • Current hospitalization of ≥ 5 days
  • High frequency of antibiotic resistance in the community or in the specific hospital unit
  • Immunosuppressive disease and/or therapy
  • Presence of risk factors for HCAP:
  • Hospitalization ≥2 days in the preceding 90 days
  • Residence in a nursing home or extended care facility
  • Home infusion therapy (including antibiotics)
  • Chronic dialysis within 30 days
  • Home wound care
  • Family member with multidrug-resistant pathogen
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Yes
Start empirical therapy with combined broad spectrum antibiotics
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No
Start empirical therapy with limited spectrum antibiotics
Click here for more detail
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
After 2-3 days, check cultures and assess the clinical response based on:
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Does the patient improved his clinical status after 48-72 hours?
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Yes
Assess culture results
 
 
 
 
 
No
Assess culture results
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Positive Culture
 
Negative Culture
 
Positive Culture
 
Negative Culture
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
De-escalate antibiotics, treat for 7-8 more days and re-evaluate
 
Consider stopping antibiotics
 
Adjust antibiotic regimen based on culture susceptibility, look for other infection sites and complications
 
Look for other pathogens, infection sites and complications
 
 
 
References

References

  1. ↑ “Guidelines for the Management of Adults with Hospital-acquired, Ventilator-associated, and Healthcare-associated Pneumonia”. American Journal of Respiratory and Critical Care Medicine. 171 (4): 388–416. 2005. doi:10.1164/rccm.200405-644ST. ISSN 1073-449X.

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Alejandro Lemor, M.D. [2]