In this episode of the Hospital Medicine podcast, I'm going to try and tackle the treatment of health care associated pneumonia and ventilator associated pneumonia.

We talked a lot about ventilator associated pneumonia in the last episode, but we really haven't defined what we categorize health care associated pneumonia to be according to the

American Theracic Society. So right now, when we talk about health care associated pneumonia,

we're talking about people who are admitting from a long-term care facility or nursing home.

Anybody that's been hospitalized in the last 90 days, though, by definition, their

hospitalization must have lasted 48 hours or more. Anybody who's been exposed to broad-spectrum

antibiotics in the past 30 days. Likewise, anybody who's immunosuppressed or gets hemodialysis or gets wound care has a health care-associated pneumonia.

More and more data is rolling in about health care associated pneumonia.

For instance, there was a study in clinical infectious disease in May of 2013.

That was titled, Re-Admission Following Hospitalization for Pneumonia,

the impact of pneumonia type and its implication for hospitals.

One of the findings of that study that was not very surprising

is that re-emission rate is higher for healthcare associated pneumonia than

community-acquired pneumonia. But what was surprising is they did not find a correlation between

inappropriate antibiotic therapy and readmission. In fact, in the conclusion of that study,

the author say, and I'm quoting them,

the variables associated with readmission do not reflect factors that hospitals directly control.

And with pneumonia readmissions currently being a factor both in payment and just quality metrics that are posted to the public.

The fact that sometimes we really don't have a huge influence from the hospital side of things on readmissions can be frustrating both to the hospitals and to the physicians that are being judged on those quality metrics.

Now, one reason that health care acquired pneumonia patients do readmit is obviously they are a sicker

population. They either been in the hospital recently or they're getting dialysis or they have

chronic wounds. And then there's this issue that community-acquired pneumonia patients

...