PURPOSE: Health care associated pneumonia (HCAP) has recently been described as distinct entity from community-acquired pneumonia (CAP). HCAP is associated with higher mortality and higher prevalence of multi-drug resistant pathogens as compared to patients with CAP. Our objective was to compare the etiology and mortality of HCAP versus, of CAP.
METHODS: A retrospective cohort study was conducted at two tertiary teaching hospitals. Data was abstracted on 787 eligible subjects that were admitted with a diagnosis of CAP (by ICD-9 codes) between 1/1/1999 and 12/31/2001 and had radiological confirmation. Subjects were excluded if they were on “comfort measures only” or were transferred from another hospital. A modified definition of HCAP was defined as patients that were admitted from a nursing home, or chronic dialysis at the time of admission. Severity of illness was assessed using the pneumonia severity index (PSI). A logistic regression analysis was performed with 30-day mortality as the dependent measure and the PSI and HCAP, as the independent variables.
RESULTS: Seventy patients (9%) had HCAP and 717 (91%) had CAP. HCAP patients were older (p<.001), predominantly males (p=.04), had more congestive heart failure (p<.001), chronic renal disease (p<.001), altered mental status (p<.001), hypotension (p=.01), increased BUN (p<.001), and were less likely to receive guideline concordant therapy (p=.04)as compared to patients with CAP. HCAP patients had similar rates of Pseudomonas aeruginosa (1.4%) vs. 2.6%; p=.5), and Staphylococcus aureus (5.7% vs. 5.2%; p=.8), and less Streptococcus pneumoniae (0 vs. 8.4%); p=.01) than CAP patients. Mortality was higher in HCAP patients (20%) vs. CAP (8%) (p=.001), but not statistically significant different after adjusting for severity of illness (OR=1.4, 95% CI 0.70-2.79; p=.34). HCAP patients had similar length of stay in days (SD) (7.6(15.7) vs. 7.6(8.3); p=.9).
CONCLUSION: HCAP patients admitted to the hospital tend to be sicker, and have higher mortality and different etiology pattern than CAP patients.
CLINICAL IMPLICATIONS: Further studies should evaluate the impact of having health care associated factors in hospitalized patients with pneumonia, especially to define appropriate antibiotic therapy.
DISCLOSURE: Patricia Castellanos-Mateus, No Financial Disclosure Information; No Product/Research Disclosure Information