“The rationale for inclusion of the HCAP designation with the HAP/VAP guidelines in 2005 was that patients with HCAP were thought to be at high risk for MDR organisms by virtue of their contact with the healthcare system. Therefore, due to both the patients’ contact with the healthcare system and the presumed high risk of MDR pathogens, guidelines for these patients were included with guidelines for HAP and VAP, the HAPs. However, in subsequent years, these 2 rationales for including HCAP with the HAP/VAP recommendations have come into question. There is increasing evidence from a growing number of studies that many patients defined as having HCAP are not at high risk for MDR pathogens. Furthermore, although interaction with the healthcare system is potentially a risk for MDR pathogens, underlying patient characteristics are also important independent determinants of risk for MDR pathogens.
Even if HCAP would be considered as a separate clinical entity, it was thought that this could be included in the upcoming community-acquired pneumonia (CAP) guidelines because patients with HCAP, like those with CAP, frequently present from the community and are initially cared for in emergency departments.
Finally, in light of the more recent data regarding the HCAP population, the panel anticipated that recommendations regarding coverage for MDR pathogens among community-dwelling patients who develop pneumonia would likely be based on validated risk factors for MDR pathogens, not solely on whether or not the patient had previous contacts with the healthcare system. For these reasons, the panel unanimously decided that HCAP should not be included in the HAP/VAP guidelines.” IDSA 2016 Guidelines.