PURPOSE: Healthcare-associated pneumonia (HCAP) is defined for appropriate empiric antimicrobial treatment for a subset of community-acquired pneumonia (CAP). HCAP patients have more comorbid illnesses and a higher risk of multiple drug resistant (MDR) pathogens than patients with CAP. However, it is still controversial whether HCAP correlates with poorer outcomes.
METHODS: A secondary analysis was conducted of the Community -Acquired Pneumonia database, which contains retrospectively collected data on African American(AA) patients with culture positive CAP from January 2005 to December 2006. The patients were divided into two groups, HCAP and CAP. Length of stay (LOS) in hospital, LOS in ICU, and in-hospital mortality were defined as outcomes. The severity of pneumonia was measured using PSI classes. A logistic regression model was used for mortality analysis to adjust for potential confounders.
RESULTS: Two hundred and seven patients with CAP were identified, of whom 118 (57%) were diagnosed with HCAP. Mean age (±SD) of CAP and HCAP were 57±16 and 62± 17 years old respectively (p<0001). Co-morbidity frequencies (HCAP and CAP respectively and p value) were neurological diseases (53%, 8%, and <0.0001), chronic kidney diseases (43%, 18%, and <0.0001), Diabetes (33%, 15%, and 0.002), and HIV/AIDS (13%, 39% and <0.0001). The most common isolated pathogens (HCAP and CAP respectively and p value) were methicillin-resistant Staphylococcus aureus (MRSA) (33%, 19%, 0.025), Pseudomonas aeruginosa (22%,11%,0.042), and Streptococcus pneumoniae (3%, 24% and <0.0001). MDR pathogens were isolated from 75 (64%) of the patients with HCAP compared to 27(31%) of the CAP patients (p<0.0001). In the univariate outcome study, LOS>10 days were seen in 68 (58%) and 31 (39%) of HCAP and CAP patients respectively (p=0.001). In-hospital mortality in HCAP and CAP were 20% and 10% respectively (p=0.047). However, multivariate analysis showed HCAP was not significantly associated with mortality (p=0.254).
CONCLUSIONS: In this analysis, patients with culture positive HCAP were older, had more comorbidities, more frequent MDR pathogens, but did not have higher mortality when compared with CAP patients.
CLINICAL IMPLICATIONS: These data suggest that AA patients with HCAP need more aggressive empirical antibiotic therapy.
DISCLOSURE: The following authors have nothing to disclose: Padmaraj Duvvuri, Mehdi Mirsaeidi, Qasim Durrani, Muhammad Shibli
No Product/Research Disclosure Information