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Clinical Investigations: INFECTION |

Multicenter Study of Hospital-Acquired Pneumonia in Non-ICU Patients*

Nieves Sopena, MD, PhD; Miquel Sabrià, MD, PhD; the Neunos 2000 Study Group
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Affiliations: *From the Infectious Diseases Unit, University Hospital Germans Trias i Pujol, Badalona (Barcelona), Spain.,  A list of Neunos 2000 Study Group members is given in the Appendix.

Correspondence to: Nieves Sopena, MD, PhD, Unitat de Malalties Infeccioses. Hospital Universitari Germans Trias i Pujol, C/Canyet s/n, Badalona CP 08916 (Barcelona), Spain; e-mail: nsopena@ns.hugtip.scs.es



Chest. 2005;127(1):213-219. doi:10.1378/chest.127.1.213
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Study objective: To know the incidence, epidemiology, etiology, and outcome of hospital-acquired pneumonia (HAP) in non-ICUs adult patients.

Setting: Twelve Spanish teaching hospitals.

Interventions: From April 1999 to November 2000, non-ICU HAP was prospectively studied by active, bimonthly 1-week surveillance. Epidemiologic data, etiology, and evolution of pneumonia were recorded. Blood and sputum cultures and Legionella pneumophila and Streptococcus pneumoniae urinary antigen tests were performed.

Results: We included 186 patients, with complete data available in 165 patients (70.3% male gender; mean age, 63.7 ± 16.9 years [ ± SD]) The mean incidence of HAP was 3 ± 1.4 cases/1,000 hospital admissions. Most patients (64.2%) were in medical wards, had severe underlying diseases (66.6%), and had a hospital stay > 5 days (76.4%). Blood cultures were performed in 139 patients (84.2%), sputum cultures were performed in 89 patients (53.9%), and urinary antigen detection was performed in 123 patients (74.5%). An etiologic diagnosis was obtained in 60 cases (36.4%), and 31 were definitive. The most frequent etiologies were S pneumoniae (16 cases, 14 definitive), L pneumophila (7 cases, 7 definitive), Aspergillus sp (7 cases, 3 definitive), Pseudomonas aeruginosa (7 cases, 2 definitive), and several Enterobacteriaceae (8 cases, 4 definitive). Clinical complications occurred in 52.1% of the cases, and mortality was 26% (13.9% attributed to pneumonia).

Conclusions: Non-ICU HAP is an important cause of hospital morbidity, observed most frequently in medical wards and elderly patients with severe underlying diseases. In this setting, S pneumoniae and Legionella sp should be considered in addition to other nosocomial pathogens; urinary antigen detection is useful in determining the prevalence of these microorganisms.


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