Scientific publications

Ten Issues to Update in Nosocomial or Hospital-Acquired Pneumonia: An Expert Review

Oct 14, 2023 | Magazine: Journal of Clinical Medicine

Francisco Javier Candel  1 , Miguel Salavert  2 , Angel Estella  3   4 , Miquel Ferrer  5 , Ricard Ferrer  6 , Julio Javier Gamazo  7 , Carolina García-Vidal  8 , Juan González Del Castillo  9 , Víctor José González-Ramallo  10 , Federico Gordo  11 , Manuel Mirón-Rubio  12 , Javier Pérez-Pallarés  13 , Cristina Pitart  14 , José Luís Del Pozo  15   16 , Paula Ramírez  17 , Pedro Rascado  18 , Soledad Reyes  19 , Patricia Ruiz-Garbajosa  20 , Borja Suberviola  21 , Pablo Vidal  22 , Rafael Zaragoza  23


Nosocomial pneumonia, or hospital-acquired pneumonia (HAP), and ventilator-associated pneumonia (VAP) are important health problems worldwide, with both being associated with substantial morbidity and mortality. HAP is currently the main cause of death from nosocomial infection in critically ill patients.

Although guidelines for the approach to this infection model are widely implemented in international health systems and clinical teams, information continually emerges that generates debate or requires updating in its management.

This scientific manuscript, written by a multidisciplinary team of specialists, reviews the most important issues in the approach to this important infectious respiratory syndrome, and it updates various topics, such as a renewed etiological perspective for updating the use of new molecular platforms or imaging techniques, including the microbiological diagnostic stewardship in different clinical settings and using appropriate rapid techniques on invasive respiratory specimens.

It also reviews both Intensive Care Unit admission criteria and those of clinical stability to discharge, as well as those of therapeutic failure and rescue treatment options. An update on antibiotic therapy in the context of bacterial multiresistance, in aerosol inhaled treatment options, oxygen therapy, or ventilatory support, is presented. It also analyzes the out-of-hospital management of nosocomial pneumonia requiring complete antibiotic therapy externally on an outpatient basis, as well as the main factors for readmission and an approach to management in the emergency department.

Finally, the main strategies for prevention and prophylactic measures, many of them still controversial, on fragile and vulnerable hosts are reviewed.

CITATION  J Clin Med. 2023 Oct 14;12(20):6526.  doi: 10.3390/jcm12206526