The clinical challenge of diagnosing non-ventilator hospital acquired pneumonia and identifying causative pathogens - a narrative review.
Quarton, Samuel Livesey, Alana Pittaway, Harriet Adiga, Aditya Grudzinska, Frances McNally, Alan Dosanjh, Davinder Sapey, Elizabeth Parekh, Dhruv
Quarton, Samuel
Livesey, Alana
Pittaway, Harriet
Adiga, Aditya
Grudzinska, Frances
McNally, Alan
Dosanjh, Davinder
Sapey, Elizabeth
Parekh, Dhruv
Abstract
Non-ventilated hospital acquired pneumonia (NV-HAP) is associated with significant healthcare burden, arising from high incidence and associated morbidity and mortality. However, accurately identifying cases remains challenging. At present there is no gold-standard test for the diagnosis of NV-HAP, requiring instead the blending of non-specific signs and investigations. Causative organisms are only identified in a minority of cases. This has significant implications for surveillance, patient outcomes and antimicrobial stewardship. Much of the existing research in HAP has been conducted among ventilated patients. The paucity of dedicated NV-HAP research means conclusions regarding diagnostic methods, pathology and interventions must largely be extrapolated from work in other settings. Progress is also limited by the lack of a widely agreed definition for NV-HAP. The diagnosis of NV-HAP has large scope for improvement. Consensus regarding a case definition will allow meaningful research to improve understanding of both aetiology and the heterogeneity of outcomes experienced by patients. There is potential to optimise the role of imaging and to incorporate novel techniques to identify likely causative pathogens. This would facilitate both antimicrobial stewardship and surveillance of an important healthcare-associated infection. This narrative review considers the utility of existing methods to diagnose NV-HAP, with a focus on the significance and challenge of identifying pathogens. It discusses the limitations in current techniques and explores the potential of emergent molecular techniques to improve microbiological diagnosis and outcomes for patients.
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Date
2024-04-13
Type
Article
Subject
Respiratory medicine
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Citation
Quarton S, Livesey A, Pittaway H, Adiga A, Grudzinska F, McNally A, Dosanjh D, Sapey E, Parekh D. Clinical challenge of diagnosing non-ventilator hospital-acquired pneumonia and identifying causative pathogens: a narrative review. J Hosp Infect. 2024 Jul;149:189-200. doi: 10.1016/j.jhin.2024.02.029. Epub 2024 Apr 15.
Journal / Source Title
Journal of Hospital Infection
DOI
10.1016/j.jhin.2024.02.029
PMID
38621512
Publisher
W.B. Saunders
Publisher’s URL
http://www.sciencedirect.com/science/journal/01956701