Risk Factors

These guidelines are based on local studies and national clinical guidelines for pneumonia

Historical risk factors for healthcare-associated pneumonia (HCAP) were published in a previous version of ATS/IDSA HAP/VAP/HCAP Guidelines from 2005

HCAP Risk Factors:

• Residence in a nursing home or extended care facility

• Hospitalization for ≥2 days in the preceding 90 days

• Home infusion therapy, home wound care, or chronic dialysis within 30 days, or

• Family member with a multidrug-resistant (MDR) organism

Subsequent research demonstrated HCAP risk factors had a limited ability to predict for MDR organisms and, due to their low specificity, favored unnecessary overutilization of broad-spectrum antibiotics

Thus, the HCAP designation was omitted from the current 2016 IDSA/ATS HAP/VAP Guidelines, and the panel stated further recommendations for community-onset pneumonia will likely be based on validated risk factors for MDR organisms. These recommendations are expected in a pending update to the 2007 IDSA/ATS Community-acquired Pneumonia Guidelines

Current national guidelines strongly encourage customization of local guidelines based on local epidemiology and antimicrobial resistance data

In 2018, a local study was published evaluating pneumonia in adult hospitalized patients at Prisma Health-Midlands. It identified local risk factors to predict for both susceptible and resistant Pseudomonas aeruginosa, respectively, compared to other respiratory bacterial pathogens. (See reference 1)

These local guidelines reflect the risk factors identified in this study combined with other local data on predicting antimicrobial resistance