What follow-up investigations are necessary to monitor the response to treatment in patients diagnosed with HAP?

Follow-up investigations to monitor response to treatment in hospital-acquired pneumonia (HAP) include:

• Clinical reassessment of symptoms and signs to ensure improvement or detect deterioration, as symptoms should steadily improve with treatment.
• Repeat chest X-ray is recommended after 6 weeks in adults if symptoms and signs persist despite treatment or if the patient is at higher risk of underlying malignancy (e.g., smokers or those over 50 years old).
• Microbiological testing results should be reviewed to guide antibiotic choice and consider narrowing spectrum if appropriate.
• Ongoing monitoring of vital signs and oxygen saturation during hospital stay to assess clinical progress.

Routine repeat chest X-rays during the acute phase are not explicitly recommended unless clinical deterioration occurs or symptoms persist beyond expected recovery times.

There is no specific mention of routine laboratory markers (e.g., CRP) or other imaging modalities for HAP follow-up in the provided guidelines, but clinical judgement and microbiological results guide management.

Advice on immunization (pneumococcal and influenza) after recovery is also part of follow-up care.

Patients should be advised to seek medical review if their condition deteriorates or does not improve as expected.

References: ¹, ²