Healthcare-associated infections. A useful concept?

To provide an overview of the importance of healthcare-associated infections (HCAI) as a new concept in infectious diseases. Although described originally in bacteremia, the concept has also been applied to other infections such as pneumonia and endocarditis.

Therapeutic protocols recommend treating HCAI with broad-spectrum antibiotics to cover infection due to multidrug-resistant pathogens (MDR). Nonetheless, the prevalence of MDR pathogens may vary considerably in different subgroups of HCAI and in different countries. Patients categorized as having HCAI usually present atypical symptoms that may delay diagnosis; moreover, outcome is worse than community-acquired infections. Although several studies have reported that inappropriate empiric therapy may explain adverse outcomes in HCAI, careful adjustment for other conditions should be taken into account, such as baseline comorbidities, therapeutic limitations, and delay in the initiation of antibiotic treatment.

In patients with HCAI, complementary workup should be systematically performed in search of a microbiologic diagnosis. Broad-spectrum antibiotics should not be prescribed automatically, especially in countries with lower prevalence of MDR pathogens. Some refinements of the definition are needed and specific risk factors for infection by MDR microorganisms should be assessed.