Health Care–Associated Pneumonia: A New Clinical Entity

We read with great interest the article by Carratalà and coworkers¹ describing the epidemiology, antibiotic therapy, and outcome of health care–associated pneumonia (HCAP). The authors concluded that HCAP should be regarded as a separate category of respiratory tract infection, with its peculiar epidemiologic and microbiological characteristics and outcomes.¹

These findings agree with an ongoing multicenter, prospective survey on patients with pneumonia hospitalized in internal medicine wards in Italy. This study, supported by the Italian Society of Internal Medicine (SIMI), involved medical wards of 49 Italian hospitals (both teaching and nonteaching hospitals). Participating centers recorded clinical and microbiological data of all patients with a definite diagnosis of pneumonia observed during an active 1-week surveillance performed from January 22 to January 29 and June 25 to July 2, 2007. A patient was considered to have an HCAP if he or she fulfilled any of the following criteria: (1) attended a hospital or hemodyalisis clinic or received intravenous chemotherapy in the 30 days before pneumonia, (2) was admitted to an acute care hospital for at least 2 days in the 180 days before pneumonia, or (3) resided in a nursing home or a long-term care facility. Patients included were followed up until discharge or death. To detect significant differences between groups, we used the χ² or Fisher exact test for categorical variables and the 2-tailed t test for continuous variables.