Healthcare associated pneumonia does not accurately identify potentially resistant pathogens: a systematic review and meta-analysis

Introduction. The 2005 ATS/IDSA guidelines introduced a concept of "healthcare-associated pneumonia" (HCAP) to define patients at higher risk of antibiotic resistant pathogens, requiring broad spectrum therapy. There has been no systematic evaluation of the ability of this definition to identify antibiotic resistant pathogens. Methods. A systematic review and meta-analysis of studies comparing the frequency of resistant pathogens (defined as methicillin-resistant Staphylococcus aureus, enterobacteriaceae and Pseudomonas aeruginosa) in populations with HCAP compared to community-acquired pneumonia(CAP). Predictive accuracy was evaluated using the area under the receiver operator characteristic curve(AUC). The frequency of pathogens in each group were pooled using a random effects model. Results. 24 studies were included (N=22,456). Overall study quality was poor. HCAP was associated with an increased risk of MRSA Odds Ratio (OR) 4·72 (3·69-6·04, enterobactericeae 2·11 (1·69-2·63), and P.aeruginosa 2·75 (2·04-3·72): all p