PURPOSE: The concept of healthcare-associated pneumonia (HCAP) was devised to identify patients with increased risk for infection with resistant pathogens despite residing in the community. It is unknown how well the current ATS-IDSA HCAP-defining criteria actually identify such at-risk patients when all criteria are rigorously applied to a general hospitalized population.
METHODS: In this single-center study we retrospectively reviewed the charts of all hospitalizations in 2008 with an ICD-9 code for pneumonia and identified patients with HCAP. We recorded the presence/absence of each individual HCAP-defining criterion and recorded microbiology data regarding infection with resistant pathogens.
RESULTS: The study cohort included 523 patients of whom 280 (54%) met at least one HCAP-defining factor. Microbiology data identified at least one pathogen in 36% of subjects. The presence of at least one ATS-IDSA HCAP-defining criterion had a sensitivity of 64% and a specificity of 49% in identifying patients infected by a resistant organism. Although univariate analysis found that some HCAP-defining criteria were associated with infection caused by a resistant organism (immunosuppression, nursing home resident, prior hospitalization), others were not (hemodialysis, prior antibiotics, chemotherapy, outpatient infusion, wound care, hospital based clinic). Multivariate logistic regression modeling identified variables independently associated with pneumonia caused by a resistant pathogen. These included: the clinical pulmonary infection score (AOR 1.53, p<0.001); the APACHE II score (AOR 1.03, p=0.04); and the current ATS-IDSA definition of HCAP (AOR 2.54, p<0.001).
CONCLUSION: Although HCAP is a commonly encountered subtype of pneumonia, its optimal definition merits more rigorous study. In this study population, current HCAP-defining criteria and increased severity of illness identified patients at-risk for infection caused by resistant pathogens.
CLINICAL IMPLICATIONS: Creation of a more parsimonious HCAP definition could minimize excessive antibiotic prescription.
DISCLOSURE: Joshua Holweger, No Financial Disclosure Information; No Product/Research Disclosure Information