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Abstract: Poster Presentations |

HEALTHCARE-ASSOCIATED PNEUMONIA: THE STATE OF EVIDENCE TO DATE?A QUALITATIVE REVIEW FREE TO VIEW

Marya D. Zilberberg, MD*; Marin H. Kollef, MD; Andrew F. Shorr, MD
Author and Funding Information

EviMed Research Group, LLC, Goshen, MA


Chest


Chest. 2009;136(4_MeetingAbstracts):50S. doi:10.1378/chest.136.4_MeetingAbstracts.50S-b
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Abstract

PURPOSE:  The evolution of healthcare-associated infection as a concept attests to the need for clinicians to recognize the proliferation healthcare delivery, as many of the traditionally hospital-based interventions now transpire in the ambulatory arena. Healthcare-associated pneumonia (HCAP) is a separate entity in the spectrum of pneumonia. Because of its emerging importance and widely differing pathogen make-up and outcomes in some recent studies, we examined in detail the 5 cohort studies published to date in HCAP to identify the potential reasons for these disparate findings and to identify current knowledge gaps.

METHODS:  We conducted a qualitative review of literature with a pooled unadjusted mortality analysis.

RESULTS:  Differences in case definition were the likely reason for disparate microbiology and outcomes. Compared to community-acquired pneumonia (CAP), HCAP patients have consistently higher severity of illness, a higher risk of infection with resistant pathogens, and are more likely to be treated with inappropriate empiric therapy, which increases their mortality risk > 2-fold. In a pooled analysis, where no inter-study statistical heterogeneity was identified, the crude relative risk of mortality in HCAP vs. CAP was 2.16, (95% confidence interval 1.86 to 2.51). Limiting this analysis to the two prospective studies resulted in the pooled relative risk of death of 2.51 (95% confidence interval 1.58 to 3.96) for HCAP vs. CAP. Broad knowledge gaps remain, including the validity of the HCAP definition and the value of guideline-concordant therapy.

CONCLUSION:  HCAP is an important emerging syndrome, and a systematic approach to its study is critical. As evidence in this area builds, it is important to set the research agenda to fill knowledge gaps.

CLINICAL IMPLICATIONS:  To optimize outcomes, clinicians must recognize risk factors for resistant pathogens in patients presenting with pneumonia from the community. HCAP definition may help tailor appropriate empiric antimicrobial therapy.

DISCLOSURE:  Marya Zilberberg, Grant monies (from industry related sources) Research grant from Ortho-McNeil Janssen; Shareholder Shareholder in Johnson&Johnson; No Product/Research Disclosure Information

Tuesday, November 3, 2009

12:45 PM - 2:00 PM


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