Nursing home-acquired pneumonia: an emergency department treatment algorithm

Abstract

Nursing home-acquired pneumonia (NHAP) is a leading cause of morbidity, hospitalization, and mortality among older nursing home residents. Too often, these patients are erroneously grouped with cases of community-acquired and hospital-acquired pneumonia. Yet, they differ in terms of most common pathogens, significant underlying disease, impaired functional and cognitive status, and poor nutrition. The NHAP emergency department treatment algorithm presented here shows that an important decision for initial care in the emergency department (ED) is whether the patient should return to the nursing home. This decision often is based on the facility's ability to administer parenteral antibiotics, and care for co-morbidities and complications. Cephalosporins are the foundation of initial treatment of NHAP in the ED, and are combined with other antibiotics in anticipation of the most likely pathogens and treatment variables discussed here. It is hoped the NHAP treatment algorithm will contribute to improved outcomes.

C-Reactive Protein, Procalcitonin, Clinical Pulmonary Infection Score, and Pneumonia Severity Scores in Nursing Home Acquired Pneumonia

“…1,2,[8][9][10]12,17,[20][21][22][23][24] The results from our study showed that CURB-65 and the pneumonia severity index were more accurate in predicting in-hospital mortality from NHAP compared with the other pneumonia severity scores. The findings are in agreement with previous studies 10,20,24 but in contrast to other studies.…”

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

“…12,13 One common limitation to all these scoring models is that not one takes into consideration the functional status of nursing home residents. 3,12 Although NHAP was more severe than CAP, the proportion of subjects admitted to the ICU was similar, except in region II (28% vs 18%, P ϭ .09). We found that subjects with NHAP are older with a higher frequency of comorbidities.…”

“…However, it should be noted that outbreaks of Legionella infection have been reported in nursing homes. 3 Prospective clinical and environmental surveillance of nursing homes has revealed previously unsuspected Legionella infection because of colonization of the facilities' water supply by Legionella. 21 Viral infection in nursing homes is seasonal.…”

“…Patients with NHAP often suffer from more severe disease, with many comorbidities and functional status as the major determinants of survival. 3 The appropriate management of NHAP remains questionable because of the controversial status of its microbial etiology. Data from the United States [4][5][6] indicate an excess of multidrug-resistant (MDR) pathogens in patients with NHAP, but studies from Europe do not confirm this.…”

Immunogenicity of a 23-valent pneumococcal polysaccharide vaccine in elderly residents of a long-term care facility

“…Recent data suggest that the rate of CAP in the US is 18.2 cases per 1,000 person-years in persons aged 65 to 69 years, rises to 52.3 cases per 1,000 person-years in those aged 85 years and older, and in nursing home residents, the rates of CAP are estimated to be more than 300 cases per 1,000 person-years [5][6][7]. The annual incidence of invasive infections due to Streptococcus pneumoniae in adults older than 64 years in Chile, in a followup period of five years, has been reported to be 234/100,000 [8].…”