Recently published papers: pulmonary care, pandemics, and eugenics in surviving sepsis?

Health-care-associated pneumonia (HCAP) refers to a pulmonary infection that develops in individuals recently hospitalised, or undergoing renal replacement therapy or other long-term out-patient care. Over the past few years it has been postulated that this reflects a distinct group of pathogens with consequent implications for therapy and also on outcome. However, no study had looked at the pathogens of both HCAP and community-acquired pneumonia (CAP) and compared them with those of hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP).Kollef et al. [1] have attempted to do this by retrospective analysis of a large USA database of culture-positive pneumonia, in 59 US centres over a 1-year period. The study defined 4,543 positive pneumonias, of which 2,221 were CAP, 988 HCAP, 853 HAP and 499 VAP. The results showed that patients with HCAP were slightly older than those with CAP but were broadly similar to those with HAP. Half of the patients with HCAP came from nursing homes. Illness severity was almost identical in both HCAP and VAP, but was higher than in HAP and CAP. Bacterial pathogen identification showed a high rate of Staphylococcus aureus infection in all types of pneumonia but this may be an artefact; however, also of interest was the low rate of pneumococcal infection in CAP. Overall, bacterial species in HCAP were broadly similar to those in HAP and VAP; Pseudomonas accounted for just over 25% and methicillin-resistant S. aureus 56%, with the rest made up of the usual Gram-negative types. It was also noted that patient mortality for HCAP was similar to that for HAP but higher than that for CAP and lower than that for VAP.The authors suggest that HCAP is a distinct entity from CAP and should be treated as a hospital-acquired type of infection from first presentation; the paper certainly supports the recently published guidelines from the American Thoracic Society [2].Staying with the pulmonary sepsis theme, Lacherade et al. [3] shed f