2039. Evaluation Of Diagnostic Considerations In The Evaluation Of Hospital Acquired Pneumonia


 
 
 Hospital-Acquired Pneumonia (HAP), defined as pneumonia that occurs 48 hours or more after hospital admission, is considered a part of the health care-associated infections (HAIs). HAIs are one of the top ten causes of death in the United States. Correct diagnosis of HAIs is key to reducing its impact, however, the diagnosis of HAP is challenging because clinical findings are nonspecific and there is no combination of signs, symptoms, and laboratory or imaging results that can predict this diagnosis with a good sensitivity or specificity. This study aims to clarify the prioritization of clinical elements considered in the diagnosis of HAP by physicians at our center.
 
 
 
 This is a cross-sectional study at a large, tertiary care academic center in Miami, Florida. The target population included hospitalists, internal medicine residents, critical care and infectious disease fellows. REDCap was used to administer the survey and collect data. A rank individual analysis was conducted to assess for the most significant diagnostic criteria overall. Kruskal-Wallis analysis was conducted to assess for significance of the individual diagnostic criteria.
 
 
 
 At the end of the survey period, 130 people responded (45.8% of sent surveys). Overall Kruskal-Wallis rank sum test of the systemic factors showed significant differences between the diagnostic criteria chosen. The presence of a new or worsening infiltrate on imaging was selected as most important. After that, fever, a positive respiratory culture, worsening hypoxia and new cough and shortness of breath were in the second tier of important criteria (Figure 1). The median number of factors needed to have HAP in the differential diagnosis and start empiric treatment was 3, while the needed number to secure the diagnosis of HAP was 4. In an immunocompromised patient, the median number of factors needed was 2 (Figure 2). Color red, represents selection 1 - meaning, the larger the tab, it means that specific factor was highly considered as the first factor in the diagnosis of HAP.
 Color green represents second most selected factor
 Color blue represents third most selected factor
 Upper box: median number of factors needed to secure the diagnosis of HAP
 Mid box: median number of factors needed to include HAP as the differential diagnosis in an immunocompromised patient
 Lower box: media number of factors needed to have HAP in the differential and start empirical treatment
 
 
 
 In this study, we observed that the most highly considered criteria for the diagnosis of HAP are new or worsening infiltrate on imaging, new or worsening hypoxia, and respiratory cultures with growth of a classical respiratory pathogen. Most of these criteria are part of the IDSA guidelines on the evaluation and treatment of HAP. Future directions include developing a decision support tool for diagnosing HAP.
 
 
 
 All Authors: No reported disclosures.
