Hospital-Acquired Pneumonia and Ventilator-Associated Pneumonia: A Literature Review

Abstract

Hospital-acquired pneumonia (HAP) and its subtype, ventilator-associated pneumonia (VAP), remain two significant causes of morbidity and mortality worldwide, despite the better understanding of pathophysiological mechanisms, etiology, risk factors, preventive methods (bundle of care principles) and supportive care. Prior detection of the risk factors combined with a clear clinical judgement based on clinical scores and dosage of different inflammatory biomarkers (procalcitonin, soluble triggering receptor expressed on myelloid cells type 1, C-reactive protein, mid-regional pro-adrenomedullin, mid-regional pro-atrial natriuretic peptide) represent the cornerstones of a well-established management plan by improving patient's outcome. This review article provides an overview of the newly approved terminology considering nosocomial pneumonia, as well as the risk factors, biomarkers, diagnostic methods and new treatment options that can guide the management of this spectrum of infections.

Keywords: bundle of care; hospital-acquired pneumonia; mid-regional pro-adrenomedullin; mid-regional pro-atrial natriuretic peptide; procalcitonin; ventilator-associated pneumonia.

Figure 1

Algorithm of detecting possible/probable ventilator-associated pneumonia with the terminology proposed by the 2013 Centers of Disease Control and Prevention; adapted from [4].

Figure 2

Definitions for ventilated and non-ventilated ICU-acquired HAP; adapted from [5].