Case history
Case history #1
A 55-year-old man with a history of peripheral vascular disease, who presents with a complaint of a left foot ulcer and pain when walking short distances, is found to have a popliteal stenosis and admitted for re-vascularisation. Four days after admission, on postoperative day 3, he develops shortness of breath, hypoxia, and a productive cough. Auscultation of his chest reveals decreased breath sounds at the lower aspect of the right side of his chest. His morning leukocyte count is slightly higher than the day before at 11,000 cells/mL3. An anterior-posterior bedside chest x-ray reveals right lower lobe opacity.
Case history #2
An 88-year-old female resident of a nursing home, who typically does not present to the acute care hospital, has frequent urinary tract infections (UTIs) that are managed by the nursing home physician. In the nursing home, she develops a UTI due to multidrug-resistant pathogens. On admission to hospital, she has poor mental status and her bed is left with the head elevated to only a 5° angle. On hospital day 4, a chest x-ray reveals a right lower lobe opacity.
Other presentations
Patients with HAP usually present with a combination of fever (or hypothermia), leukocytosis (or leukopenia), increased tracheal secretions, and poor oxygenation. An opacity on chest x-ray or computed tomography scan supports the diagnosis. Studies have shown that starting the correct antimicrobial regimen early results in better outcomes.[5] Re-evaluating patients to verify the diagnosis of HAP in order to determine the need for antimicrobials is appropriate. In general, multiple comorbidities contribute to worse outcomes in patients with HAP.
Use of this content is subject to our disclaimer