A prospective comparison of nursing home-acquired pneumonia with hospital-acquired pneumonia in non-intubated elderly

Abstract

There are no prospective comparison of the etiology and clinical outcome between hospital-acquired pneumonia (HAP) and nursing home-acquired pneumonia (NHAP) in non-intubated elderly. This study prospectively evaluated the etiology of HAP and NHAP in non-intubated elderly. A prospective cohort study was carried out in a rural region of Japan where the population over 65 years of age represents 30% of the population. A total of 108 patients were enrolled. There were 33 patients with HAP and 75 with NHAP. Etiologic diagnosis was established in 78.8% of HAP and in 72% of NHAP patients. The most frequent pathogens were Chlamydophila pneumoniae followed by Streptococcus pneumoniae, Staphylococcus aureus and Influenza virus. The frequency of Streptococcus pneumoniae and Influenza virus was significantly higher, whereas the frequency of Staphylococcus aureus and Enterobacteriaceae was significantly lower in NHAP compared to HAP. Performance and nutritional status were significantly worse in patients with HAP than in those with NHAP. Hospital mortality was significantly lower in patients with NHAP compared to those with HAP. This study demonstrated that C. pneumoniae, Streptococcus pneumoniae, Staphylococcus aureus and Influenza virus are frequent causative agents of pneumonia in non-intubated elderly and that the responsible pathogens and clinical outcome differ between NHAP and HAP.

Characteristics and disease severity of healthcare-associated pneumonia among patients in a hospital in Kitakyushu, Japan

“…We found that patients with HCAP were older than those with CAP, results that support two studies from Japan [12,16]. Complications were also more frequently found in patients with HCAP.…”

“…Among these complications, central nerve diseases were more prevalent Seki et al, Page 15 15 in patients with HCAP, while chronic lung diseases and heart disease were more prevalent in patients with CAP. These characteristics were similar to the reports of Murayama et al [16], but much different from the results in the United States [4][5] suggesting a high frequency of aspiration pneumonia in elderly patients with old brain infarction in Japan.…”

“…It strongly suggested that a lower serum albumin level is related with elderly age and lower performance status of patients with NHAP [16], and in other study of NHAP, poor functional status has been also correlated with the presence of MDR pathogens [18]. We did not investigate patients' performance status in this study; however, performance status may be a potential prognosis factor for patients with HCAP.…”

“…Shindo et al reported that 39% of patients with HCAP had been hospitalized for at least 2 days in the preceding 90 days and 61.0% resided in a nursing home or extended care facility [12]. Maruyama et al reported that in a rural region of Japan where the population over 65 years of age represents 30% of the population, 69.4% were patients with HCAP (NHAP) and 30.6% were patients with HAP [16]. Although the proportion of patients with NHAP in our studies was relatively low, it may be due to differences in the character of each hospital and local environment.…”

A Worldwide Perspective of Nursing Home-Acquired Pneumonia Compared With Community-Acquired Pneumonia

“…In agreement, an older study by Lim et al 18 and the CAPNETZ study 19 also reported that the most common pathogen in NHAP was S. pneumoniae (55%). In a study of similar design from Japan, Maruyama et al 20 identified C. pneumoniae, S. pneumoniae, S. aureus, and influenza virus as frequent causative agents of pneumonia in nonintubated institutionalized elderly persons. Interestingly, atypical pathogens accounted for 37% of all isolates.…”