Role for risk-scoring tools in identifying resistant pathogens in pneumonia: reassessing the value of healthcare-associated pneumonia as a concept

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Purpose of reviewResistant organisms remain a concern in patients presenting to hospital with pneumonia. Although in this setting the prevalence of various organisms such as methicillin-resistant Staphylococcus aureus and Pseudomonas aeruginosa varies across the globe, patients infected with these pathogens are at increased risk for receiving an initially inappropriate antibiotic regimen – a major driver of mortality in all forms of pneumonia. The concept of healthcare-associated pneumonia (HCAP) was created to help clinicians identify persons at risk for infection with resistant pathogens, despite the onset of their infections occurring outside the hospital. However, it appears that HCAP, as currently defined, lacks adequate sensitivity and specificity for this purpose.Recent findingsInvestigators have created various risk-scoring tools to stratify patients as to the likelihood that their infection is caused by a pathogen such as methicillin-resistant S. aureus or P. aeruginosa. These scores provide more precision at correctly segregating patients on the basis of the eventual recovery of resistant bacteria than does the HCAP syndrome. Most of these risk scores are easy to calculate and apply, and several have been externally validated.SummaryPhysicians should consider adopting these tools in their approach to patients with pneumonia presenting to hospital.

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