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Nosocomial pneumonia (NP) represents a leading cause of morbidity and mortality in hospitalized patients. Historically, clinicians have considered hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP), which comprise NP, to be essentially bacterial processes. As such, patients suspected of having either HAP or VAP are initially treated with broad-spectrum antibiotics, and few clinicians search for a possible culprit virus. Recent reports which build on earlier studies, however, indicate that viruses likely play an important role in NP. Studies employing viral diagnostics as part of the evaluation for NP indicate that common respiratory viruses can spread nosocomially and lead to HAP and VAP. Similarly, studies of the general epidemiology of respiratory viral infections, such as influenza, respiratory syncytial virus, adenovirus, and rhinovirus, confirm that these pathogens are important causes of NP, especially among immunosuppressed and pediatric patients. More importantly, these more contemporary analyses reveal that one cannot, based on clinical characteristics, distinguish a viral from a bacterial cause of NP. Additionally, viral HAP and VAP result in crude mortality rates that rival or exceed those reported in bacterial NP. Rigorous prospective, multicenter trials are needed to confirm the significance of respiratory viruses in NP, as are studies of novel therapeutics for these viral infections.

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Background: Although the prevalence of mild to moderate anemia in HIV+ patients (pts) is approximately 22% in the HAART era, the incremental economic burden of anemia is not well understood. This study provides an estimate of the incremental cost of care for anemia in HIV+ pts. Methods: A longitudinal, retrospective, cohort design was employed to identify subjects in a commercial database of medical and pharmacy claims who were ≥18 years, HIV+, and enrolled in 1 healthcare plan continuously for 18 months from 1996 to 2004. Pts with anemia (A+) were identified using ICD-9 diagnosis codes or receipt of transfusion(s) in the absence of major GI bleeding, trauma or surgery. A control period of 6 months immediately prior to the 12-month study period served to evaluate comorbidity burden and disease severity. To isolate health care costs, including in- and out-patient visits and pharmacy costs, specific to anemia, multivariate regression analyses were conducted to control for demographics, comorbidities, and disease burden. Results: Of the 2,195 HIV+ subjects identified, 364 (17%) were A+. While there was no significant gender effect, each 1-year increase in age was associated with a 2.1% rise in average monthly cost. A+ cohort was associated with a 118.5% higher average cost compared to A−. The unadjusted average monthly cost for A− subjects in the post-index period was $466 compared with $1,200 for the A+ cohort. In a regression model, anemia maintained an independent and significant association with increased costs (p < 0.0001). Conclusion: The presence of anemia is associated with a substantial increase in costs among HIV+ patients, independent of demographic differences, disease severity and comorbidity burden. Prospective studies are needed to evaluate the effect of anemia correction on healthcare costs in this population.