Nursing home acquired pneumonia: approach to management.
OBJECTIVE
Pneumonia is among the leading causes of mortality in nursing home residents and a primary reason for transfer to acute care facilities. Compared with community-dwelling individuals, residents of long-term care facilities have extensive underlying medical illnesses and more functional disabilities and are at increased risk of acquiring drug-resistant pathogens. This review focuses on recent recommendations for diagnostic work up, validity of prognostic models, and current approach to treatment of nursing home acquired pneumonia (NHAP).


RESULTS
The inconsistency in defining NHAP is considered a potential hindrance for a uniform approach to the management of pneumonia. Diagnostic evaluation varies between facilities and depends on severity of illness and access to laboratory facilities. The role of prognostic models in stratifying severity of disease remains largely unknown due to paucity of studies and lack of a specific scoring system for hospitalized patients with NHAP. A controversy still exists concerning the best therapeutic option for NHAP, but it is reasonable to believe that each setting is adapting the existing evidence according to the best local practice.


CONCLUSIONS
A unified approach to defining, assessing, and stratifying pneumonia is essential to decrease morbidity and mortality in nursing home residents. High-quality randomized, controlled trials examining empiric antibiotic therapy are needed.
The Veterans Affairs Western New York Healthcare System, Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine and Social and Preventive Medicine, University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, New York, USA. solh@buffalo.edu
Ali A
AA
El-Solh
D000375:Aging / Q000276:immunology; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D003428:Cross Infection / Q000188:drug therapy* / Q000401:mortality / Q000517:prevention & control; D024881:Drug Resistance, Bacterial; D006760:Hospitalization; D006801:Humans; D009735:Nursing Homes; D018410:Pneumonia, Bacterial / Q000188:drug therapy* / Q000401:mortality / Q000517:prevention & control; D011379:Prognosis
D000900:Anti-Bacterial Agents