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Clinical Investigations: INFECTION |

Epidemiology and Outcomes of Health-care–Associated Pneumonia*: Results From a Large US Database of Culture-Positive Pneumonia

Marin H. Kollef, MD, FCCP; Andrew Shorr, MD, MPH, FCCP; Ying P. Tabak, PhD; Vikas Gupta, PharmD, BCPS; Larry Z. Liu, MD, PhD; R. S. Johannes, MD, MS
Author and Funding Information

*From the Pulmonary and Critical Care Division (Dr. Kollef), Washington University School of Medicine, St. Louis, MO; Pulmonary and Critical Care Medicine Service (Dr. Shorr), Walter Reed Army Medical Center, Washington, DC; Cardinal Health Clinical Knowledge Services Research Group (Drs. Tabak, Gupta, and Johannes), Marlborough, MA; and Pfizer Inc. (Dr. Liu), New York, NY.

Correspondence to: Marin H. Kollef, MD, FCCP, Campus Box 8052, Washington University School of Medicine, 660 South Euclid Ave, St. Louis, MO 63110; e-mail: mkollef@im.wustl.edu



Chest. 2005;128(6):3854-3862. doi:10.1378/chest.128.6.3854
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Context: Traditionally, pneumonia developing in patients outside the hospital is categorized as community acquired, even if these patients have been receiving health care in an outpatient facility. Accumulating evidence suggests that health-care–associated infections are distinct from those that are truly community acquired.

Objective: To characterize the microbiology and outcomes among patients with culture-positive community-acquired pneumonia (CAP), health-care–associated pneumonia (HCAP), hospital-acquired pneumonia (HAP), and ventilator-associated pneumonia (VAP).

Design and setting: A retrospective cohort study based on a large US inpatient database.

Patients: A total of 4,543 patients with culture-positive pneumonia admitted into 59 US hospitals between January 1, 2002, and December 31, 2003, and recorded in a large, multi-institutional database of US acute-care hospitals (Cardinal Health-Atlas Research Database; Cardinal Health Clinical Knowledge Services; Marlborough, MA).

Main measures: Culture data (respiratory and blood), in-hospital mortality, length of hospital stay (LOS), and billed hospital charges.

Results: Approximately one half of hospitalized patients with pneumonia had CAP, and > 20% had HCAP. Staphylococcus aureus was a major pathogen in all pneumonia types, with its occurrence markedly higher in the non-CAP groups than in the CAP group. Mortality rates associated with HCAP (19.8%) and HAP (18.8%) were comparable (p > 0.05), and both were significantly higher than that for CAP (10%, all p < 0.0001) and lower than that for VAP (29.3%, all p < 0.0001). Mean LOS varied significantly with pneumonia category (in order of ascending values: CAP, HCAP, HAP, and VAP; all p < 0.0001). Similarly, mean hospital charge varied significantly with pneumonia category (in order of ascending value: CAP, HCAP, HAP, and VAP; all p < 0.0001).

Conclusions: The present analysis justified HCAP as a new category of pneumonia. S aureus was a major pathogen of all pneumonias with higher rates in non-CAP pneumonias. Compared with CAP, non-CAP was associated with more severe disease, higher mortality rate, greater LOS, and increased cost.

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