Diagnosis of nonventilated hospital-acquired pneumonia: how much do we know?

To describe the current knowledge about clinical and microbiological diagnosis of nonventilated hospital-acquired pneumonia (NV-HAP).

NV-HAP is emerging as a new challenge for clinicians, particularly because VAP incidence has been decreasing. The clinical diagnosis of NV-HAP uses the classical clinical symptoms and signs. However standard evaluation of their accuracy and the evaluation of new criterion (e.g. lung ultrasound) must be conducted particularly in NV-HAP patients. The use of sputum must be encouraged in patients with NV-HAP, assuring its lower respiratory tract representativeness and quality. It is not clear that invasive approaches (e.g. BAL) are associated with improvements in patient-centred outcomes, and further research is needed to assure their correct indication, guaranteeing safety. Rapid diagnosis methods are promising in NV-HAP, particularly for the quick results and information about antibiotic resistance.

NV-HAP poses several barriers for diagnosis compared with VAP, and the available knowledge is limited. A call for further research in diagnosis of nonventilated HAP is urgent.