概述
Since the initial 1996 American Thoracic Society （ATS） guide- line on nosocomial pneumonia， a number of new developments have appeared， mandating a new evidence-based guideline for hospital-acquired pneumonia （HAP）， including healthcare-asso- ciated pneumonia （HCAP） and ventilator-associated pneumonia （VAP）。 This document， prepared by a joint committee of the ATS and Infectious Diseases Society of America （IDSA）， fo- cuses on the epidemiology and pathogenesis of bacterial pneu- monia in adults， and emphasizes modifiable risk factors for infec- tion。 In addition， the microbiology of HAP is reviewed， with an emphasis on multidrug-resistant （MDR） bacterial pathogens， such as Pseudomonas aeruginosa， Acinetobacter species， and methicillin-resistant Staphylococcus aureus。 Controversies about diagnosis are discussed， emphasizing initial examination of lower respiratory tract samples for bacteria， and the rationale for both clinical and bacteriologic approaches， using either “semiquanti- tative” or “quantitative” microbiologic methods that help direct selection of appropriate antibiotic therapy。 We also provide rec- ommendations for additional diagnostic and therapeutic evalua- tions in patients with nonresolving pneumonia。 This is an evi- dence-based document that emphasizes the issues of VAP， because there are far fewer data available about HAP in nonintu- bated patients and about HCAP。 By extrapolation， patients who are not intubated and mechanically ventilated should be man- aged like patients with VAP， using the same approach to identify risk factors for infection with specific pathogens。
