Pneumonia Isn't What it Used to Be

Robert W. Griffith, MD

1. Community-Acquired Pneumonia (CAP) is defined as pneumonia not acquired in a hospital or a long-term care facility. Patients are usually over 65 and often have a chronic disease that weakens their bodily defense mechanisms. A variety of bacteria, viruses, or fungi can be responsible. The most common cause is Streptococcus pneumoniae; others include the flu virus, mycoplasma, chlamydia, legionella, and adenovirus. Treatment begins with assessing the need for hospitalization, which can be helped by using a Severity Index . Then antibiotics, assuming the causative bug is Strep. pneumoniae, until lab results show otherwise (resistant strains are increasingly common). Vaccinations are important to prevent CAP - an annual flu shot, and a single pneumococcal vaccine shot if you're over 65 (maybe repeat at 70 or 75).

2. Hospital Acquired Pneumonia (HAP) occurs 48 hours or more following admission to hospital. It's the most common infection in patients requiring care in the intensive care unit (ICU), with an incidence of 6% up to 50%.

3. Ventilator-Associated Pneumonia (VAP) develops 48-72 hours after the patient is placed on a ventilator; it occurs in up to 1 in 4 of all such patients.

4. Healthcare Associated Pneumonia (HCAP) - this is a new category, used for those cases of pneumonia where the patient has been in contact with healthcare workers, either in hospital, a nursing home, or some other long-term care facility.

Management for types 2-4 is similar as for CAP. And a flu shot and pneumoniae vaccination are essential preventive measures for older people.

Source
HealthandAge Blog

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