Healthcare-associated pneumonia is a heterogeneous disease, and all patients do not need the same broad-spectrum antibiotic therapy as complex nosocomial pneumonia

Brito, Verónica; Niederman, Michael S.

doi:10.1097/qco.0b013e328329fa4e

Cited by 153 publications

(128 citation statements)

References 18 publications

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“…Recent studies report S. pneumoniae as one of the principal etiological NHAP agent, as well as indicate a low prevalence of MDR pathogens and question the recommendation to treat these patients with empirical broadspectrum antibiotics [15][16][17][18].…”

Section: Discussionmentioning

confidence: 99%

Nursing home-acquired pneumonia presenting at the emergency department

2016

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Nursing home-acquired pneumonia (NHAP) is one of the most common infections arising amongst nursing home residents, and its incidence is expected to increase as population ages. The NHAP recommendation for empiric broad-spectrum antibiotic therapy, arising from the concept of healthcare-associated pneumonia, has been challenged by recent studies reporting low rates of multidrug-resistant (MDR) bacteria. This single center study analyzes the results of NHAP patients admitted through the Emergency Department (ED) at a tertiary center during the year 2010. There were 116 cases, male gender corresponded to 34.5 % of patients and median age was 84 years old . Comorbidities were present in 69.8 % of cases and 48.3 % of patients had used healthcare services during the previous 90 days. In-hospital mortality rate was 46.6 % and median length-of-stay was 9 days. Severity assessment at the Emergency Department provided CURB65 index score and respective mortality (%) results: zero: n = 0; one: n = 7 (0 %); two: n = 18 (38.9 %); three: n = 26 (38.5 %); four: n = 30 (53.3 %); and five; n = 22 (68.2 %); and sepsis n = 50 (34.0 %), severe sepsis n = 43 (48.8 %) and septic shock n = 22 (72.7 %). Significant risk factors for in-hospital mortality in multivariate analysis were polypnea (p = 0.001), age C 75 years (p = 0.02), and severe sepsis or shock (p = 0.03) at the ED. Microbiological testing in 78.4 % of cases was positive in 15.4 % (n = 15): methicillinresistant Staphylococcus aureus (26.7 %), Pseudomonas aeruginosa (20.0 %), S. pneumoniae (13.3 %), Escherichia coli (13.3 %), others (26.7 %); the rate of MDR bacteria was 53.3 %. This study reveals high rates of mortality and MDR bacteria among NHAP hospital admissions supporting the use of empirical broad-spectrum antibiotic therapy in these patients.

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Section: Discussionmentioning

confidence: 99%

Nursing home-acquired pneumonia presenting at the emergency department

2016

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“…In prise a heterogeneous population with varying rates of 2005, the American Thoracic Society and the Infectious Dis-MDRO infection. 5 It is not known, however, whether outeases Society of America jointly published guidelines 3 for the comes vary according to the setting in which HCAP is acmanagement of a distinct group of patients with recent exquired. Studies have also shown that outcomes for patients posure to the healthcare system who are at increased risk of with HCAP are worse than outcomes for patients with CAP, harboring multidrug-resistant organisms (MDROs).…”

Section: Infect Control Hosp Epidemiol 2014;35(s3):s107-s115mentioning

confidence: 99%

Outcomes of Patients with Healthcare-Associated Pneumonia: Worse Disease or Sicker Patients?

Rothberg

Haessler

Lagu

et al. 2014

Infect. Control Hosp. Epidemiol.

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Background.Healthcare-associated pneumonia (HCAP) is an entity distinct from community-acquired pneumonia (CAP). HCAP has a higher case-fatality rate, due either to HCAP organisms or to the health status of HCAP patients. The contribution of HCAP criteria to case-fatality rate is unknown.Methods.We conducted a retrospective review of adult patients admitted with a diagnosis of pneumonia from July 2007 through November 2011 to 491 US hospitals. HCAP was defined as having at least 1 of the following: prior hospitalization within 90 days, hemodialysis, admission from a skilled nursing facility, or immune suppression. We compared characteristics of patients with CAP and patients with HCAP and explored the contribution of HCAP criteria to case-fatality rate in a hierarchical generalized linear model.Results.Of 436,483 patients hospitalized with pneumonia, 149,963 (34.4%) had HCAP. Compared to CAP patients, HCAP patients were older, had more comorbidities, and were more likely to require intensive care unit (ICU) care. In-hospital case-fatality rate was higher among patients with HCAP, compared to those with CAP (11.1% vs 5.1%, P < .001). After adjustment for demographics, comorbidities, presence of other infections, early ICU admission, chronic and acute medications, early tests and therapies, and length of stay, HCAP remained associated with increased case-fatality rate (odds ratio [OR], 1.35 [95% confidence interval (CI), 1.32-1.39]); odds of death increased for each additional HCAP criterion (OR [95% CI]: 1 criterion, 1.27 [1.23-1.31], 2 criteria, 1.55 [1.49-1.62], and 3 or more criteria, 1.88 [1.72-2.06]).Conclusions.After adjustment for differences in patient characteristics, HCAP was associated with greater case-fatality rate than CAP. This difference may be due to HCAP organisms or to HCAP criteria themselves.

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“…However, there is disagreement about whether current HCAP criteria clearly identify patients at risk for MDR, and concerns that over-treatment with broadspectrum antibiotics may produce selection pressure for MDR. [2][3][4] Recently, an intervention to improve guidelinebased treatment of patients with possible MDR pneumonia including HCAP, found that guideline-adherent therapy was associated with increased mortality. 5 Therefore, it is unclear if guideline-based therapy improves outcomes for patients with HCAP.…”

Section: Introductionmentioning

confidence: 99%