Identifying patients with pneumonia due to MDR organisms coming from the community

Among patients with pneumonia coming from the community, it is crucial to identify possible MDR infections at initial diagnosis in order to select the most appropriate empirical treatment and avoid broad-spectrum antibiotic overuse. Healthcare-associated pneumonia (HCAP) criteria currently do not address this issue entirely or correctly. Recent clinical studies show that HCAP criteria do not accurately identify potential MDR organisms, as several additional risk factors associated with MDR infections are now recognised that were not included in the original HCAP definition. Personalised evaluation is therefore necessary in each patient, covering general MDR risk factors and specific risk factors related to MRSA or Pseudomonas aeruginosa. Scoring systems for the stratification of MDR risk could be useful in clinical practice, but they need to be developed based on local epidemiology and specific risk factors.