Community Acquired, Nursing Home Acquired and Hospital Acquired Pneumonia: A Five‐Year Review of the Clinical, Bacteriological and Radiological Characteristics

Abstract

CW CHOW, LR LEE-PACK, N SENATHI RA GAH, M RAWJI, M CHAN, CK CHAN. Com mu nity ac quired, nurs ing home acquired and hos pi tal ac quired pneu mo nia:A five-year re view of the clini cal, bac te rio logi cal and ra dio logi cal char ac ter is tics. Can J In fect Dis 1995;6(6):317-325. PUR POSE:To as sess the con tem po rary clini cal, bac te rio logi cal and ra dio graphic fea tures of hos pi tal ized pa tients with com mu nity ac quired (CA), nurs ing home ac quired (NA) and hos pi tal ac quired pneu mo nia (HA) and to ex am ine pa tient out come. PATIENTS AND METH ODS: All hos pi tal rec ords of pa tients with pneu mo nia over a five-year pe riod from April 1987 to March 1992 were re viewed ret ro spec tively. Pa tients in cluded in the study were all those with a di ag no sis of pneu mo nia as iden ti fied by com puter rec ords of di ag nos tic codes at dis charge; pa tients with a spe cific di ag no sis of Pneu mo cys tis carinii pneu mo nia were ex cluded. Of 74,435 dis charges over the five-year pe riod, 1782 pa tients met the in clu sion cri te ria. RESULTS: Charts of 1622 of the to tal 1782 cases were re viewed. Mean age was 64.4 years with 59.4% men and 40.6% women. Sixty-three per cent were CA, 28.5% were HA and 8.5% were NA. A to tal of 1542 pa tients (95%) had at least one con comi tant medi cal con di tion. Chest roent ge no gram was ab nor mal in 97%. Com mon or gan isms iso lated over all were Hae mo phi lus in flu en zae (from 204 pa tients), Staphy lo coc cus aureas (from 152 pa tients), Strep to coc cus pneu mo niae (from 143 pa tients ), Escheri chia coli (from 113 pa tients) and Pseu do mo nas ae rugi nosa (from 111 pa tients). H in flu enzae and S pneu mo niae were most com mon in CA pneu mo nia, whereas S au reus and Gram-negative or gan isms were more com mon in the HA group and Gram-negative agents in the NA group. One hun dred and four pa tients de vel oped com pli ca tions. Fif teen per cent re quired in ten sive care unit ad mis sion. The av er age length of hos pi tali za tion in the CA and NA groups was 17 days and in the HA group, 43 days. At time of dis charge 1261 pa tients (78%) were cured or improved, and 361 pa tients (22%) died dur ing the ad mis sion. CON CLU SIONS: These re sults sug gest that hos pi tali za tion for pneu mo nia in the 1990s is pri mar ily for eld erly pa tients with sig nifi cant co-morbidity. Al though mi cro bi ol ogy ap pears un changed com pared with ear lier re ports, the con tem po rary popu la tion is sig nifi cantly sicker than pre vi ous co horts. This may ac count for the per sis tently high mor bid ity and mor tality de spite bet ter or newer an ti bi ot ics. was by August Hirsch in 1881 (1), in which he de scribed pneu mo nia to oc cur in epi dem ics and to be more preva lent in the eld erly, the sick and those of low so cio eco nomic status. This re port had fol lowed the first suc cess ful cul ture of a bac terial or gan ism from a pa tient with pneu mo nia by Louis Pas teur, who aptly named the or gan ism Strep to coc cus pneu mo niae. Hirsch'...

Inpatient Care of Community‐Acquired Pneumonia: The Effect of Antimicrobial Guidelines on Clinical Outcomes and Drug Costs in Canadian Teaching Hospitals

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Community versus hospital-acquired pneumonia in patients requiring extracorporeal membrane oxygenation

“…6,7 Some studies suggest that CAP and HAP should be regarded as distinct clinical entities since they have different clinical courses. 8,9…”

“…6,7 Some studies suggest that CAP and HAP should be regarded as distinct clinical entities since they have different clinical courses. 8,9 Although bacterial pneumonia is regarded as a favorable factor for survival after ECMO support, 10 it is unknown whether type of pneumonia (CAP or HAP) should be considered when predicting outcomes for ARDS patients treated with ECMO. The objective of this study was to identify clinical, bacteriological, and treatment characteristics in pneumonia patients who received ECMO for respiratory support according to type of pneumonia and to compare clinical outcomes between groups.…”

The Use of Guidelines for the Empiric Treatment of Hospital‐Acquired Pneumonia

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