Community-Acquired Pneumonia in Nursing-Home Residents in the Post-HCAP Era.

Abstract

Pneumonia remains a leading cause of morbidity and mortality among nursing-home (NH) residents, a population characterized by advanced age, frailty, multimorbidity, and functional dependence. The abandonment of the healthcare-associated pneumonia (HCAP) concept and evolving epidemiology have important implications for diagnosis and management in this setting. Pneumonia in NH residents often presents atypically, with non-specific symptoms such as confusion or functional decline, complicating timely diagnosis and potentially delaying appropriate treatment. Streptococcus pneumoniae remains the most commonly identified pathogen, while respiratory viruses, including influenza and respiratory syncytial virus, contribute significantly to disease burden. Although multidrug-resistant pathogens are uncommon, broad-spectrum antibiotics are used frequently, exposing patients to avoidable harm. Diagnostic challenges, including difficulty obtaining reliable respiratory samples and distinguishing colonization from infection, further complicate management. Outcomes are driven not only by infection severity but also by underlying frailty, comorbidities, and functional status. Pneumonia in NH residents should be approached as a syndrome of vulnerability rather than a standalone infectious process. Management requires individualized, risk-based antimicrobial strategies, improved diagnostic approaches, and attention to aspiration risk and goals of care. Future efforts should focus on optimizing antibiotic stewardship, preventing aspiration-related disease, and aligning treatment decisions with patient-centered outcomes.