Abstract This is the second of 2 parts of a narrative review of nursing home-associated pneumonia (NHAP) that deals with etiology and treatment in the nursing home. In the 1980s and 1990s, the etiology of NHAP was considered to be similar to community-acquired pneumonia (CAP). This belief was reflected in CAP guidelines until 2005 when the designation healthcare-associated pneumonia or HCAP was introduced and nursing home residents were included in the HCAP category. Patients in the HCAP group were thought to be at high risk for pneumonia because of multidrug resistant organisms and required empiric broad-spectrum antibiotic therapy much like people with hospital-acquired infection. Subsequent studies of the etiology of NHAP using sophisticated diagnostic testing found limited evidence of resistant organisms such as methicillin-resistant Staphylococcus aureus or resistant gram-negative organisms or atypical organisms. In terms of management of NHAP in the nursing home there are several considerations that are discussed: hospitalization decision, initial oral or parenteral therapy, timing of switch to an oral regimen if parenteral therapy is initially prescribed, duration of therapy with an emphasis on shorter courses, and follow-up during therapy including the use of the “antibiotic time out” protocol. The oral and parenteral antibiotic regimens recommended for treatment of NHAP in this report are based on limited information because there are no randomized controlled trials to define the optimum regimen. In conclusion, most residents with pneumonia can be treated successfully in the nursing home. However, there is an urgent need for a specific NHAP diagnosis and treatment guideline that will give providers guidance in the management of this infection in the nursing home.

中文翻译：

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疗养院相关肺炎，第二部分：病因和治疗

摘要 这是疗养院相关性肺炎 (NHAP) 叙述性评论的两部分中的第二部分，涉及疗养院的病因和治疗。在 1980 年代和 1990 年代，NHAP 的病因被认为与社区获得性肺炎 (CAP) 相似。这种信念一直反映在 CAP 指南中，直到 2005 年引入了指定医疗保健相关性肺炎或 HCAP 并且疗养院居民被包括在 HCAP 类别中。HCAP 组的患者被认为是肺炎的高危人群，因为存在多重耐药菌，需要经验性广谱抗生素治疗，就像医院获得性感染患者一样。随后使用复杂的诊断测试对 NHAP 病因进行的研究发现，耐药微生物的证据有限，例如耐甲氧西林金黄色葡萄球菌或耐药革兰氏阴性微生物或非典型微生物。就疗养院中 NHAP 的管理而言，讨论了几个考虑因素：住院决定、初始口服或胃肠外治疗、如果最初规定了胃肠外治疗时切换到口服方案的时间、治疗持续时间以较短的疗程为重点，以及治疗期间的随访，包括使用“抗生素暂停”方案。本报告中推荐用于治疗 NHAP 的口服和胃肠外抗生素方案基于有限的信息，因为没有随机对照试验来确定最佳方案。综上所述，大多数患有肺炎的居民都可以在疗养院成功治疗。然而，迫切需要一个特定的 NHAP 诊断和治疗指南，为提供者在疗养院中管理这种感染提供指导。