PURPOSE: Nursing Home-associated pneumonia (NHAP) is the leading cause of death among long-term care patients. NHAP is considered different from community acquired pneumonia in that it has a higher mortality and a different etiology. However, it remains unclear whether broad spectrum antibiotics might change the survival outcome of NHAP.
METHODS: A secondary analysis was conducted of the Community -Acquired Pneumonia database, which contains retrospectively collected data on African American patients with culture positive CAP from January 2005 to December 2006. Lengths of stay (LOS) in the hospital and in-hospital mortality were defined as primary outcomes. The severity of CAP was measured using PSI classes. A survival study was used to predict the probability of in-hospital mortality.
RESULTS: A total of 207 patients were included in the study. Mean age (±SD) was 74± 13.8 years. Co-morbidities included HIV/AIDS 4%, Diabetes 26%, neurological disease 76%, Chronic kidney diseases 37%, Cardiac disease 35%. Eighty eight percent of the patients with NHAP and 58.4% of the patients with non-NHAP were classified as severe pneumonia according PSI classes 4 and 5. In-hospital mortality in NHAP and non-NHAP were 20% and 14% respectively (p=0.254). The most common isolated pathogens from NHAP were methicillin-resistant Staphylococcus aureus (MRSA) (39%), Entrobacteriaceae 38%, Streptococcus pneumoniae (1.5), atypical bacteria (0.5%), Pseudomonas aeroginosa 21%. MDR pathogens were isolated from 51 (73%) of the patients with NHAP compared to 51(37%) of the patients with non NHAP (p<0.0001). LOS>10 days was found in 40 (57%) of the patients with NHAP and 59 (43%) of non-NHAP patients (p=0.055). A Kaplan-Meier survival study showed no significant differences in survival of NHAP with non-NHAP (p=0.659, log-rank test).
CONCLUSIONS: This study shows that MDR pathogens were common in African American patient with NHAP.
CLINICAL IMPLICATIONS: Broad -spectrum empirical antibiotic coverage might be indicated in African American NHAP patient, although no survival benefit has been proven. Infection control policies should be strictly followed in Nursing Homes.
DISCLOSURE: The following authors have nothing to disclose: Mehdi Mirsaeidi, Padmaraj Duvvuri, Qasim Durrani, Muhammad Shibli
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