PURPOSE: Health care associated pneumonia (HCAP) has been proposed as a new category of respiratory infection. HCAP patients show higher mortality rates than CAP patients. But it is not clear whether the poor outcome observed in HCAP patients is related to the presence of more comorbidities or to a higher incidence of antibiotic-resistant bacteria and inappropriate empirical antibiotic treatment. Thus, we aim to establish whether differences in outcomes for HCAP are due to differences in severity of pneumonia, not due to MDR pathogen.
METHODS: We conducted a retrospective observational study of patients with severe HCAP and severe CAP who were hospitalized through the emergency department in January December 2008 at Samsung Medical Center, Seoul, Korea, and compared clinical characteristics, severity, distribution of pathogen, and outcomes.
RESULTS: In total, 345 patients hospitalized with pneumonia were eligible, 194 (56.2%) patients were severe pneumonia (PSI score ≥ 4). Severe HCAP was significantly more common than severe CAP (66.5 % vs. 33.5 % p=0.001). There were no differences between non-severe pneumonia and severe pneumonia in distribution of pathogens. And there were no differences between severe HCAP and severe CAP in the occurrence of potentially drug-resistant pathogens (23.4% vs. 14.2%; P = 0.397) and inappropriate initial antimicrobial treatment (21.3% vs. 9.5%; P = 0.244). And in early case-fatality rate (< 48h) and in-hospital mortality, there were no differences between two groups (3.1% vs. 6.2%; P = 0.394 and 21.3% vs. 9.5%; P = 0.244).
CONCLUSION: Differences in outcomes for HCAP are due to differences in severity of pneumonia, not due to MDR pathogen.
CLINICAL IMPLICATIONS: Differences in outcomes for HCAP are due to differences in severity of pneumonia, not due to MDR pathogen.
DISCLOSURE: Eun Ju Jeon, No Financial Disclosure Information; No Product/Research Disclosure Information