Questions and issues of nonventilated hospital-acquired pneumonia: an opinion document

Nonventilated hospital-acquired pneumonia (NV-HAP) is a significant cause of morbidity and mortality within healthcare settings. Despite advancements in diagnostic and therapeutic approaches over recent decades, the supporting evidence for diagnostic criteria remains limited. Information regarding the aetiology of this condition is scarce, and many methodological aspects related to the collection and analysis of respiratory samples are still under debate. Furthermore, recommendations from leading scientific societies on these topics vary and have not been updated in many instances.

Our aim was to critically assess the current understanding of NV-HAP diagnosis and management, highlight gaps in the existing literature, provide perspectives from a team specializing in infectious diseases and clinical microbiology, and identify areas where future research should be directed.

We have formulated a series of questions addressing various facets of NV-HAP to a multidisciplinary group of experts and conducted a literature review to seek appropriate answers.

We present our insights mainly on topics where evidence is lacking. The subjects covered include the definition of the condition, epidemiological factors, recommendations for diagnosis and microbiological sample collection, radiological evaluation, and empirical treatment strategies.

This narrative review highlights the heterogeneity in major guidelines regarding NV-HAP, offers practical recommendations for clinical decision-making, and identifies priorities for future research.