A Comparison of Culture-Positive and Culture-Negative Health-Care-Associated Pneumonia

Labelle, Andrew; Arnold, Heather; Reichley, Richard M.; Micek, Scott T.; Kollef, Marin H.

doi:10.1378/chest.09-1652

Cited by 94 publications

(67 citation statements)

References 25 publications

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“…A prospective study of non-ICU HCAP and HAP patients that excluded patients at high risk for Pseudomonas or MRSA found no difference in outcome between cefepime or ertapenem, and recent studies report that culturenegative HCAP patients may be successfully de-escalated to antibiotics without anti-MRSA or anti-pseudomonal therapy. [21][22][23] These studies highlight the need to consider differences in study criteria when applying results to specific HCAP populations. Study strengths include the VISN20 Data Warehouse that provided a detailed integrated outpatient and inpatient medical record, permitting identification of prior healthcare exposures, and both antibiotic and non-antibiotic variables.…”

Section: Discussionmentioning

confidence: 99%

Guideline-Based Antibiotics and Mortality in Healthcare-Associated Pneumonia

et al. 2012

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Section: Discussionmentioning

confidence: 99%

Guideline-Based Antibiotics and Mortality in Healthcare-Associated Pneumonia

et al. 2012

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“…However, Attridge et al 27 reported that guideline-concordant HCAP therapy is not associated with improved survival compared with guideline-concordant CAP therapy, in nonsevere HCAP. This result may be due to the high prevalence of culture-negative infections, which can be treated effectively following a CAP regimen 28,29 , or to a low local prevalence of resistant pathogens 30 . Unfortunately, because none of our patients had received anti-MRSA therapy, we could not assess the relation between HCAP guideline-concordant therapy 1 and outcome.…”

Section: Discussionmentioning

confidence: 99%

Etiology and Factors Contributing to Mortality in Healthcare-associated Pneumonia: A Single-center Study

Ishiguro¹,

Takayanagi²,

Gochi³

et al. 2013

Showa Univ J Med Sci

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: Factors contributing to mortality in healthcare-associated pneumonia HCAP have not been investigated fully. We reviewed the etiology and identi ed prognostic factors of HCAP in hospitalized patients. We conducted a retrospective study of 500 Japanese patients with HCAP to assess these factors, with special emphasis on microbial etiology. Patients with HCAP were older 73.4 11.4 years , more predominantly male 74.4 , and had more smoking history and comorbidity than did community-acquired pneumonia CAP patients. Microbes were identi ed in 52.8 of HCAP patients. The most frequent causative microbial agents were Streptococcus pneumoniae n 108, 21.6 , influenza virus n 47, 9.4 , and Pseudomonas aeruginosa n 40, 8.0 . Multiple drug-resistant MDR pathogens were more frequent in HCAP patients 9.8 than CAP patients. Overall, 47 HCAP patients 9.4 died, with mortality being higher in HCAP than CAP patients. The three leading causes of non-survival from HCAP were S. pneumoniae, in uenza virus, and P. aeruginosa. MDR pathogens accounted for 21.3 of non-survivors. Multivariate analysis revealed disease severity on admission and treatment failure of initial antibiotics as independent factors for 30-day mortality. Among patients with treatment failure of initial antibiotics, 29.9 had received appropriate antibiotics. The most frequent pathogens in HCAP were S. pneumoniae, in uenza virus, and P. aeruginosa, in both survivors and nonsurvivors. Disease severity on admission and treatment failure of initial antibiotics were independent factors for mortality. MDR pathogens are important therapeutic targets to mitigate negative results, and treatment strategies other than antibiotic selection are also required.

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“…The original definition is acknowledged by most to be too broad and is leading to excessive antibiotic use (16). A comparison of culture-positive and culture-negative cases of HCAP confirmed that culturenegative patients were generally less ill and could be treated with conventional CAP therapy without excess length of stay or mortality (17). Because culture results can only distinguish retrospectively, further refinement of the HCAP definition is clearly needed.…”

Section: Treatmentmentioning

confidence: 99%