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

Rothberg, Michael B.; Haessler, Sarah; Lagu, Tara; Lindenauer, Peter K.; Pekow, Penelope S.; Priya, Aruna; Skiest, Daniel J.; Zilberberg, Marya D.

doi:10.1086/677829

Cited by 34 publications

(10 citation statements)

References 20 publications

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“…In contrast to some other populations, where both resistance and IET contribute to a rise in mortality we did not find that to be the case in the overall cUTI cohort [ 15 – 18 ]. This is likely due to the low (2%) baseline mortality rate compared to infections such as healthcare- and ventilator-associated pneumonia and sepsis, where crude case fatality ranges from 10 to 40% [ 11 , 12 , 15 – 22 ]. This lack of a mortality effect in our study mirrors that in other low-risk of death infections, including severe skin infection [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

Multiple antimicrobial resistance and outcomes among hospitalized patients with complicated urinary tract infections in the US, 2013–2018: a retrospective cohort study

Zilberberg¹,

Nathanson

Sulham

et al. 2021

BMC Infect Dis

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Background Complicated urinary tract infection (cUTI) is common among hospitalized patients. Though carbapenems are an effective treatment in the face of rising resistance, overuse drives carbapenem resistance (CR). We hypothesized that resistance to routinely used antimicrobials is common, and, despite frequent use of carbapenems, associated with an increased risk of inappropriate empiric treatment (IET), which in turn worsens clinical outcomes. Methods We conducted a retrospective cohort study of patients hospitalized with a culture-positive non-CR cUTI. Triple resistance (TR) was defined as resistance to > 3 of the following: 3rd generation cephalosporins, fluoroquinolones, trimethoprim-sulfamethoxazole, fosfomycin, and nitrofurantoin. Multivariable models quantified the impact of TR and inappropriate empiric therapy (IET) on mortality, hospital LOS, and costs. Results Among 23,331 patients with cUTI, 3040 (13.0%) had a TR pathogen. Compared to patients with non-TR, those with TR were more likely male (57.6% vs. 47.7%, p < 0.001), black (17.9% vs. 13.6%, p < 0.001), and in the South (46.3% vs. 41.5%, p < 0.001). Patients with TR had higher chronic (median [IQR] Charlson score 3 [2, 4] vs. 2 [1, 4], p < 0.001) and acute (mechanical ventilation 7.0% vs. 5.0%, p < 0.001; ICU admission 22.3% vs. 18.6%, p < 0.001) disease burden. Despite greater prevalence of empiric carbapenem exposure (43.3% vs. 16.2%, p < 0.001), patient with TR were also more likely to receive IET (19.6% vs. 5.4%, p < 0.001) than those with non-TR. Although mortality was similar between groups, TR added 0.38 (95% CI 0.18, 0.49) days to LOS, and $754 (95% CI $406, $1103) to hospital costs. Both TR and IET impacted the outcomes among cUTI patients whose UTI was not catheter-associated (CAUTI), but had no effect on outcomes in CAUTI. Conclusions TR occurs in 1 in 8 patients hospitalized with cUTI. It is associated with an increase in the risk of IET exposure, as well as a modest attributable prolongation of LOS and increase in total costs, particularly in the setting of non-CAUTI.

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Section: Discussionmentioning

confidence: 99%

Multiple antimicrobial resistance and outcomes among hospitalized patients with complicated urinary tract infections in the US, 2013–2018: a retrospective cohort study

Zilberberg¹,

Nathanson

Sulham

et al. 2021

BMC Infect Dis

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“…We included adult patients hospitalized with an International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) principal diagnosis code of pneumonia or a principal diagnosis of respiratory failure or sepsis paired with a secondary diagnosis of pneumonia, as described previously [ 11–13 ]. Pneumonia was defined as bacterial CAP if it was a community-acquired (present on admission) infection, antibiotic treatment was initiated by hospital day 1 and continued for at least 3 consecutive days or until discharge, and a positive blood or respiratory culture was obtained on the first day of hospitalization.…”

Section: Methodsmentioning

confidence: 99%

Epidemiology and Outcomes of Community-Acquired Escherichia coli Pneumonia

John

Deshpande

Brizendine

et al. 2021

Open Forum Infectious Diseases

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Objective To describe the epidemiology, risk factors and outcomes of community-acquired Escherichia coli pneumonia in comparison to other gram-negative and pneumococcal pneumonias. Methods E.coli is an under recognized cause of bacterial community-acquired pneumonia (CAP). We conducted a large retrospective cohort study of adult patients admitted with pneumonia to 173 US hospitals included in Premier Research database from July 2010–June 2015. Patients were included if they had principal diagnosis code for pneumonia, or a principal diagnosis of respiratory failure or sepsis with secondary diagnosis of pneumonia and had a positive blood or respiratory culture obtained on hospital day 1. The primary outcome was in-hospital case fatality. Secondary outcomes included intensive care unit (ICU) admission, invasive mechanical ventilation (IMV) and use of vasopressors. Results Of 8,680 patients with pneumonia and positive blood or respiratory cultures, 1,029 (7.7%) had E.coli CAP. Patients with E.coli pneumonia were older and more likely to have a principal diagnosis of sepsis. Patients with E.coli pneumonia had significantly higher case fatality than patients with pneumococcal pneumonia (adjusted odds ratio, 1.55 [95% CI, 1.23–1.97]) but not significantly different than other gram-negative pneumonias (adjusted odds ratio, 1.06 [95% CI, 0.85–1.32]). Approximately 36% of the isolates were resistant to fluoroquinolones; 9.3% were resistant to ceftriaxone. Conclusions E.coli is an important cause of severe CAP; with higher mortality than pneumococcal pneumonia but similar to other gram-negative pneumonias. The rate of fluoroquinolone resistance was high and empiric fluoroquinolones should be used with caution in these patients.

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“…Age, smoking, environmental exposures, malnutrition, previous or existing respiratory conditions, functional impairment, and immunosuppressive therapy are important risk factors for community-acquired pneumonia (CAP) in adults [ 28 ]. Healthcare-associated pneumonia (HCAP) is distinct from CAP and has a higher case fatality rate [ 29 ]. Influenza is a virus that typically circulates in a seasonal pattern; up to 20% of the population is infected in any given year [ 30 ].…”

Section: Discussionmentioning

confidence: 99%

Diet and Respiratory Infections: Specific or Generalized Associations?

Horn

Achenbach

et al. 2022

Nutrients

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Background: Based on our recently reported associations between specific dietary behaviors and the risk of COVID-19 infection in the UK Biobank (UKB) cohort, we further investigate whether these associations are specific to COVID-19 or extend to other respiratory infections. Methods: Pneumonia and influenza diagnoses were retrieved from hospital and death record data linked to the UKB. Baseline, self-reported (2006–2010) dietary behaviors included being breastfed as a baby and intakes of coffee, tea, oily fish, processed meat, red meat (unprocessed), fruit, and vegetables. Logistic regression estimated the odds of pneumonia/influenza from baseline to 31 December 2019 with each dietary component, adjusting for baseline socio-demographic factors, medical history, and other lifestyle behaviors. We considered effect modification by sex and genetic factors related to pneumonia, COVID-19, and caffeine metabolism. Results: Of 470,853 UKB participants, 4.0% had pneumonia and 0.2% had influenza during follow up. Increased consumption of coffee, tea, oily fish, and fruit at baseline were significantly and independently associated with a lower risk of future pneumonia events. Increased consumption of red meat was associated with a significantly higher risk. After multivariable adjustment, the odds of pneumonia (p ≤ 0.001 for all) were lower by 6–9% when consuming 1–3 cups of coffee/day (vs. <1 cup/day), 8–11% when consuming 1+ cups of tea/day (vs. <1 cup/day), 10–12% when consuming oily fish in higher quartiles (vs. the lowest quartile—Q1), and 9–14% when consuming fruit in higher quartiles (vs. Q1); it was 9% higher when consuming red meat in the fourth quartile (vs. Q1). Similar patterns of associations were observed for influenza but only associations with tea and oily fish met statistical significance. The association between fruit and pneumonia risk was stronger in women than in men (p = 0.001 for interaction). Conclusions: In the UKB, consumption of coffee, tea, oily fish, and fruit were favorably associated with incident pneumonia/influenza and red meat was adversely associated. Findings for coffee parallel those we reported previously for COVID-19 infection, while other findings are specific to these more common respiratory infections.

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

Cited by 34 publications

References 20 publications

Multiple antimicrobial resistance and outcomes among hospitalized patients with complicated urinary tract infections in the US, 2013–2018: a retrospective cohort study

Multiple antimicrobial resistance and outcomes among hospitalized patients with complicated urinary tract infections in the US, 2013–2018: a retrospective cohort study

Epidemiology and Outcomes of Community-Acquired Escherichia coli Pneumonia

Diet and Respiratory Infections: Specific or Generalized Associations?

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