Antimicrobial Resistance and Clinical Outcomes in Nursing Home-Acquired Pneumonia, Compared to Community-Acquired Pneumonia

Abstract

PurposePatients with nursing home-acquired pneumonia (NHAP) should be treated as hospital-acquired pneumonia (HAP) according to guidelines published in 2005. However, controversy still exists on whether the high mortality of NHAP results from multidrug resistant pathogens or underlying disease. We aimed to outline differences and factors contributing to mortality between NHAP and community-acquired pneumonia (CAP) patients.Materials and MethodsWe retrospectively evaluated patients aged 65 years or older with either CAP or NHAP from 2008 to 2014. Patients with healthcare-associated pneumonia other than NHAP or HAP were excluded.ResultsAmong 317 patients, 212 patients had CAP and 105 had NHAP. Patients with NHAP had higher mortality, more frequently used a ventilator, and had disease of higher severity than CAP. The incidences of aspiration, tube feeding, and poor functional status were higher in NHAP. Twenty three out of 54 NHAP patients and three out of 62 CAP patients had multidrug resistant pathogens (p<0.001). Eleven patients with NHAP died at discharge, compared to 7 patients with CAP (p=0.009). However, there was no association between mortality rate and presence of multidrug-resistant pathogens. The number of involved lobes on chest X-ray [odds ratio (OR)=1.708; 95% confidence interval (CI), 1.120 to 2.605] and use of mechanical ventilation (OR=9.537; 95% CI, 1.635 to 55.632) were significantly associated with in-hospital mortality.ConclusionPatients with NHAP had higher mortality than patients with CAP. The excess mortality among patients with NHAP and CAP was related to disease severity but not to the presence of multidrug resistant pathogens.

Guideline for Antibiotic Use in Adults with Community-acquired Pneumonia

“…The most important causative bacteria of bacterial pneumonia are S. pneumoniae . They account for 27-69% of all causative bacteria of bacterial pneumonia [ 3 4 5 6 7 8 9 10 ]. Haemophilus or Moraxella, which are respiratory pathogens, commonly cause pneumonia in patients with a lung disease.…”

“…Respiratory viruses were detected in 60 patients (18.3%) [ 5 ]. Influenza virus was the most common (n = 23, 38%), followed by RSV (n = 9, 15%), rhinovirus (n = 7, 12%), coronavirus (n = 6, 10%), adenovirus (n = 6, 10%), metapneumovirus (n = 5, 8%), parainfluenza virus (n = 3, 5%) [ 6 ]. When a respiratory virus test was performed on patients with community-acquired pneumonia hospitalized in ICU, more than one type of respiratory virus was detected in 72 of 198 patients (36.4%) for whom RT-PCR was performed [ 14 ].…”

Disease Burden and Etiologic Distribution of Community-Acquired Pneumonia in Adults: Evolving Epidemiology in the Era of Pneumococcal Conjugate Vaccines

“…Among CAP cases caused by identified bacterial pathogens, S. pneumoniae is the most important causative species, accounting for 26.9–69.4% of pneumonia cases in South Korea (Table 2) [48], and the proportion of pneumococcal pneumonia was higher in studies confined to older adults [749]. However, in a study of severe CAP cases admitted to intensive care units (ICUs), S. aureus infection was more common compared to S. pneumoniae (37.8% vs. 13.5%) [46].…”

“…Although IPDs were already reported as markedly decreased in both children and adults in the PCV13 era, data on pneumococcal CAP is still insufficient [5051]. The introduction of PCVs was expected to affect the etiologic distribution of CAP; however, significant change was not observed after the introduction of the pediatric PCV7 conjugate vaccine [5495253545556]. Even in the early period of PCV13 use, S. pneumoniae still remained as the predominant agent causing CAP in South Korea, at 26.9–43.6% in the pre-PCV7 period, 23.2–69.4% in the post-PCV7 period, and 13.5–46.8% in the post-PCV13 period (Table 2) [744454647].…”

“…Based on this evidence, the 2005 ATS/IDSA guidelines for nosocomial pneumonia included recommendations for HCAP treatment, suggesting empirical coverage of MDR pathogens [3]. Since then, subsequent studies were conducted in South Korea, Japan, and Spain, but most studies showed that S. pneumoniae is the most common causative agent of HCAP, similar to CAP (Table 3) [567894445464954556162636465]. In addition, although the proportion of MDR pathogens is higher in HCAP, some studies revealed indistinguishable etiologic distribution of causative agents between HCAP and CAP [56789].…”