Pneumonia treated in the internal medicine department: focus on healthcare-associated pneumonia

Giannella, Maddalena; Pinilla, Blanca; Capdevila, J.A.; Alarcón, J. Martínez; Muñóz, Patricia; Álvarez, Julia; Bouza, Emilio

doi:10.1111/j.1469-0691.2011.03757.x

Cited by 66 publications

(56 citation statements)

References 29 publications

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“…pneumoniae was the most frequent pathogen of HCAP, and the frequency of atypical pathogens was 9.0 , results compatible with those of previous reports 3,4,[9][10][11][12] . Although the frequency of atypical pathogens was lower in HCAP than in CAP, the 9.0 incidence of atypical pathogens should not be ignored.…”

Section: Discussionsupporting

confidence: 92%

“…In the present study, urinary antigen tests, serological analysis, and RIDT were also used in the etiological diagnosis, with cases of unknown etiology also included. More recent studies have revealed that the most frequent pathogen is S. pneumoniae, and atypical pathogens have been detected in 0.7 to 16.1 of cases 3,4,[9][10][11][12] . In the present study, S.…”

Section: Discussionmentioning

confidence: 99%

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Etiology and Factors Contributing to Mortality in Healthcare-associated Pneumonia: A Single-center Study

Ishiguro¹,

Takayanagi²,

Gochi³

et al. 2013

Showa Univ J Med Sci

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: Factors contributing to mortality in healthcare-associated pneumonia HCAP have not been investigated fully. We reviewed the etiology and identi ed prognostic factors of HCAP in hospitalized patients. We conducted a retrospective study of 500 Japanese patients with HCAP to assess these factors, with special emphasis on microbial etiology. Patients with HCAP were older 73.4 11.4 years , more predominantly male 74.4 , and had more smoking history and comorbidity than did community-acquired pneumonia CAP patients. Microbes were identi ed in 52.8 of HCAP patients. The most frequent causative microbial agents were Streptococcus pneumoniae n 108, 21.6 , influenza virus n 47, 9.4 , and Pseudomonas aeruginosa n 40, 8.0 . Multiple drug-resistant MDR pathogens were more frequent in HCAP patients 9.8 than CAP patients. Overall, 47 HCAP patients 9.4 died, with mortality being higher in HCAP than CAP patients. The three leading causes of non-survival from HCAP were S. pneumoniae, in uenza virus, and P. aeruginosa. MDR pathogens accounted for 21.3 of non-survivors. Multivariate analysis revealed disease severity on admission and treatment failure of initial antibiotics as independent factors for 30-day mortality. Among patients with treatment failure of initial antibiotics, 29.9 had received appropriate antibiotics. The most frequent pathogens in HCAP were S. pneumoniae, in uenza virus, and P. aeruginosa, in both survivors and nonsurvivors. Disease severity on admission and treatment failure of initial antibiotics were independent factors for mortality. MDR pathogens are important therapeutic targets to mitigate negative results, and treatment strategies other than antibiotic selection are also required.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Etiology and Factors Contributing to Mortality in Healthcare-associated Pneumonia: A Single-center Study

Ishiguro¹,

Takayanagi²,

Gochi³

et al. 2013

Showa Univ J Med Sci

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“…66 Spanish hospitals found similar case-fatality rates for HCAP as well as high rates of infection with MRSA and Pseudomonas sp. 17 Both studies confirmed the need to differentiate HCAP from CAP in prescribing guidelines. In contrast, a more recent study from the United Kingdom' 6 found that although HCAP patients had a 30-day mortality rate more than twice that of CAP patients, after adjustment for baseline pneumonia severity index, comorbidities, and antimicrobial therapy, the odds of mortality with HCAP fell to 1.29 and were no longer significant.…”

Section: Discussionmentioning

confidence: 70%

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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“…While several studies on adherence to guidelines of empirical antibiotic therapy for CAP have been conducted in medical wards and intensive care units [6,[13][14][15], a relatively small number of studies have investigated adherence in patients with healthcare-associated pneumonias such as HAP or HCAP [7,[16][17][18][19].…”

Section: Discussionmentioning

confidence: 99%

Adherence to antibiotic treatment guidelines and outcomes in the hospitalized elderly with different types of pneumonia

Rossio¹,

Franchi²,

Ardoino³

et al. 2015

European Journal of Internal Medicine

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Background: Few studies evaluated the clinical outcomes of Community Acquired Pneumonia (CAP), Hospital-Acquired Pneumonia (HAP) and Health Care-Associated Pneumonia (HCAP) in relation to the adherence of antibiotic treatment to the guidelines of the Infectious Diseases Society of America (IDSA) and the American Thoracic Society (ATS) in hospitalized elderly people (65 years or older). Methods: Data were obtained from REPOSI, a prospective registry held in 87 Italian internal medicine and geriatric wards. Patients with a diagnosis of pneumonia (ICD-9 480-487) or prescribed with an antibiotic for pneumonia as indication were selected. The empirical antibiotic regimen was defined to be adherent to guidelines if concordant with the treatment regimens recommended by IDSA/ATS for CAP, HAP, and HCAP. Outcomes were assessed by logistic regression models. Results: A diagnosis of pneumonia was made in 317 patients. Only 38.8% of them received an empirical antibiotic regimen that was adherent to guidelines. However, no significant association was found between adherence to guidelines and outcomes. Having HAP, older age, and higher CIRS severity index were the main factors associated with in-hospital mortality. Conclusions: The adherence to antibiotic treatment guidelines was poor, particularly for HAP and HCAP, suggesting the need for more adherence to the optimal management of antibiotics in the elderly with pneumonia

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Pneumonia treated in the internal medicine department: focus on healthcare-associated pneumonia

Cited by 66 publications

References 29 publications

Etiology and Factors Contributing to Mortality in Healthcare-associated Pneumonia: A Single-center Study

Etiology and Factors Contributing to Mortality in Healthcare-associated Pneumonia: A Single-center Study

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

Adherence to antibiotic treatment guidelines and outcomes in the hospitalized elderly with different types of pneumonia

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