{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T11:43:35Z","timestamp":1792410215193,"version":"4.4.0"},"reference-count":31,"publisher":"Public Library of Science (PLoS)","issue":"6","license":[{"start":{"date-parts":[[2022,6,29]],"date-time":"2022-06-29T00:00:00Z","timestamp":1656460800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Healthcare-associated pneumonia (HCAP) lies in the intersection of community-acquired pneumonia (CAP) and hospital-acquired pneumonia (HAP). Although HCAP is excluded from the revised HAP guideline, reassessment for HCAP is needed considering its heterogeneous characteristics.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>The microbiological distribution, antibiotic resistance, and clinical outcomes in CAP, HCAP, and HAP were studied retrospectively. The susceptibility to standard CAP regimens (\u03b2-lactams plus macrolide or fluoroquinolone monotherapy) and rates of methicillin-resistant <jats:italic>Staphylococcus aureus<\/jats:italic> (MRSA) and <jats:italic>Pseudomonas aeruginosa<\/jats:italic> (<jats:italic>P<\/jats:italic>. <jats:italic>aeruginosa<\/jats:italic>) infections were evaluated in the CAP group and HCAP subgroups.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>In total, 933 cases were included (CAP, n = 557; HCAP, n = 264; HAP, n = 112). In the CAP and HCAP cases, <jats:italic>Streptococcus pneumoniae<\/jats:italic> (7.4% vs. 5.7%) and <jats:italic>P<\/jats:italic>. <jats:italic>aeruginosa<\/jats:italic> (9.2% vs. 18.6%) were the most common gram-positive and gram-negative pathogens. <jats:italic>Staphylococcus aureus<\/jats:italic> (methicillin-resistant, 2.7%; methicillin-susceptible, 2.4%) and carbapenem-resistant <jats:italic>Acinetobacter baumannii<\/jats:italic> (20.5%) were the most common Gram-positive and Gram-negative pathogens in the HAP group, respectively. Higher susceptibility to levofloxacin was observed in CAP and HCAP isolates than that to \u03b2-lactam agents. However, levofloxacin non-susceptibility was significantly higher in long-term care facility (LTCF)-onset HCAP compared to community-onset HCAP (43.6% vs. 22.7%, <jats:italic>P<\/jats:italic> = 0.014).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>HCAP showed higher rates of <jats:italic>P<\/jats:italic>. <jats:italic>aeruginosa<\/jats:italic> and MRSA infections than CAP. Empirical antipseudomonal therapy should be considered in the treatment of HCAP. Prior isolation of <jats:italic>P<\/jats:italic>. <jats:italic>aeruginosa<\/jats:italic> was the most important risk factor for <jats:italic>P<\/jats:italic>. <jats:italic>aeruginosa<\/jats:italic> infection.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0270261","type":"journal-article","created":{"date-parts":[[2022,6,29]],"date-time":"2022-06-29T17:33:21Z","timestamp":1656524001000},"page":"e0270261","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":18,"title":["Risk factor-based analysis of community-acquired pneumonia, healthcare-associated pneumonia and hospital-acquired pneumonia: Microbiological distribution, antibiotic resistance, and clinical 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Joo","family":"Kim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2022,6,29]]},"reference":[{"key":"pone.0270261.ref001","volume-title":"Global Health Estimates 2020: Deaths by Cause, Age, Sex, by Country and by Region, 2000\u20132019","author":"WHO","year":"2020"},{"issue":"4","key":"pone.0270261.ref002","doi-asserted-by":"crossref","first-page":"388","DOI":"10.1164\/rccm.200405-644ST","article-title":"Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia","volume":"171","author":"Infectious Diseases Society of A","year":"2005","journal-title":"Am J Respir Crit Care Med"},{"issue":"3","key":"pone.0270261.ref003","doi-asserted-by":"crossref","first-page":"330","DOI":"10.1093\/cid\/cit734","article-title":"Healthcare-associated pneumonia does not accurately identify potentially resistant pathogens: a systematic review and 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