Presentation, etiology and outcome of pneumonia in younger nursing home residents

Klapdor, Benjamin; Ewig, Santiago; Schaberg, T.; Rohde, Gernot; Pletz, Mathias W.; Schütte, Hartwig; Welte, Tobias

doi:10.1016/j.jinf.2012.02.003

Cited by 15 publications

(16 citation statements)

References 19 publications

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“…Our study is in line with another study of NHAP in terms of mortality. In other studies, the reported 30-day mortality of NHAP ranged from 16.8% to 26.6%, as in our study (19.5%) 101416171819. The higher mortality in NHAP, compared with CAP, is well known, while greater detection of MDR pathogens is controversial.…”

Section: Discussionsupporting

confidence: 42%

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Antimicrobial Resistance and Clinical Outcomes in Nursing Home-Acquired Pneumonia, Compared to Community-Acquired Pneumonia

et al. 2017

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PurposePatients with nursing home-acquired pneumonia (NHAP) should be treated as hospital-acquired pneumonia (HAP) according to guidelines published in 2005. However, controversy still exists on whether the high mortality of NHAP results from multidrug resistant pathogens or underlying disease. We aimed to outline differences and factors contributing to mortality between NHAP and community-acquired pneumonia (CAP) patients.Materials and MethodsWe retrospectively evaluated patients aged 65 years or older with either CAP or NHAP from 2008 to 2014. Patients with healthcare-associated pneumonia other than NHAP or HAP were excluded.ResultsAmong 317 patients, 212 patients had CAP and 105 had NHAP. Patients with NHAP had higher mortality, more frequently used a ventilator, and had disease of higher severity than CAP. The incidences of aspiration, tube feeding, and poor functional status were higher in NHAP. Twenty three out of 54 NHAP patients and three out of 62 CAP patients had multidrug resistant pathogens (p<0.001). Eleven patients with NHAP died at discharge, compared to 7 patients with CAP (p=0.009). However, there was no association between mortality rate and presence of multidrug-resistant pathogens. The number of involved lobes on chest X-ray [odds ratio (OR)=1.708; 95% confidence interval (CI), 1.120 to 2.605] and use of mechanical ventilation (OR=9.537; 95% CI, 1.635 to 55.632) were significantly associated with in-hospital mortality.ConclusionPatients with NHAP had higher mortality than patients with CAP. The excess mortality among patients with NHAP and CAP was related to disease severity but not to the presence of multidrug resistant pathogens.

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Section: Discussionsupporting

confidence: 42%

“…To avoid the effect of age, we restricted the analysis to patients aged 65 years or more. Klapdor, et al14 showed that NHAP in older adult patients was different from younger patients. CAP in older adults also has different clinical characteristics and outcomes, compared with CAP, in younger patients 15.…”

Section: Discussionmentioning

confidence: 99%

Antimicrobial Resistance and Clinical Outcomes in Nursing Home-Acquired Pneumonia, Compared to Community-Acquired Pneumonia

et al. 2017

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“…NHAP typically affects the elderly patient population that has multiple comorbidities [ 25 ]. Several studies that have investigated NHAP in hospitalized patients show mean ages to be 74–82 years, while the 30-day mortality is reported to range from 16.8% to 24.7% [ 16 , 25 – 31 ]. A study in Germany by Klapdor et al [ 25 ] utilizing prospective multicenter data examined 618 patients and compared an older subset (65 years or older) to those less than 65 years.…”

Section: Discussionmentioning

confidence: 99%

Predictors of Mortality for Nursing Home-Acquired Pneumonia: A Systematic Review

Dhawan

Pandya

Khalili

et al. 2015

BioMed Research International

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Background. Current risk stratification tools, primarily used for CAP, are suboptimal in predicting nursing home acquired pneumonia (NHAP) outcome and mortality. We conducted a systematic review to evaluate current evidence on the usefulness of proposed predictors of NHAP mortality. Methods. PubMed (MEDLINE), EMBASE, and CINAHL databases were searched for articles published in English between January 1978 and January 2014. The literature search elicited a total of 666 references; 580 were excluded and 20 articles met the inclusion criteria for the final analysis. Results. More studies supported the Pneumonia Severity Index (PSI) as a superior predictor of NHAP severity. Fewer studies suggested CURB-65 and SOAR (especially for the need of ICU care) as useful predictors for NHAP mortality. There is weak evidence for biomarkers like C-reactive protein and copeptin as prognostic tools. Conclusion. The evidence supports the use of PSI as the best available indicator while CURB-65 may be an alternative prognostic indicator for NHAP mortality. Overall, due to the paucity of information, biomarkers may not be as effective in this role. Larger prospective studies are needed to establish the most effective predictor(s) or combination scheme to help clinicians in decision-making related to NHAP mortality.

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“…10,[13][14][15] Particularly, in the study of Klapdor et al, 16 from Germany, the results suggest that age and comorbidities are the main determinants of outcomes in NHAP. Other studies from Europe have evaluated NHAP and found Streptococcus pneumoniae to be the most frequent pathogen with low MDR prevalence, but with higher mortality than CAP.…”

Section: Nursing Home-associated Pneumoniamentioning

confidence: 94%

Hcap

Liapikou¹,

Polverino²,

Torres³

2014

Clinical Pulmonary Medicine

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Health care-associated pneumonia (HCAP) includes a broad spectrum of patients who acquire pneumonia through outpatient contact with the health system. It has been suggested that HCAP merits a distinct therapeutic approach, because its epidemiology, causative organisms, and antibiotic susceptibilities may differ from those of community-acquired pneumonia, characterized by an excess of multidrug-resistant pathogens. HCAP was included in the 2005 American Thoracic Society/Infectious Diseases Society of America guidelines for nosocomial pneumonia, with the recommendation that all such patients receive empiric therapy with a multidrug antibiotic regimen. Over the last few years there has been a controversy over whether HCAP is associated with more frequent drug-resistant pathogens (not in Europe) and whether the higher mortality is due to inappropriate therapy or the poor functional status of the HCAP patients. Further studies have shown that therapy consistent with HCAP treatment guidelines has also not been found to improve mortality. The heterogeneity of the HCAP concept affords patients a different treatment approach based on assessment of individual risk factors for multidrug resistance pathogens, but does not seem to be confirmed on the basis of current evidence from the literature.

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Presentation, etiology and outcome of pneumonia in younger nursing home residents

Cited by 15 publications

References 19 publications

Antimicrobial Resistance and Clinical Outcomes in Nursing Home-Acquired Pneumonia, Compared to Community-Acquired Pneumonia

Antimicrobial Resistance and Clinical Outcomes in Nursing Home-Acquired Pneumonia, Compared to Community-Acquired Pneumonia

Predictors of Mortality for Nursing Home-Acquired Pneumonia: A Systematic Review

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