PURPOSE: Healthcare-associated pneumonia (HCAP) is type of nosocomial pneumonia that is often misclassified as community-acquired pneumonia (CAP). Previous studies have not characterized HCAP patients from a review of individual medical records. We sought to compare the demographics, clinical features, processes of care and outcomes of HCAP and CAP patients.
METHODS: 150 consecutive patients with an admission diagnosis of pneumonia from January 1 to Dec 31 2005 were evaluated by a retrospective chart review and categorized as HCAP (as per AJRCCM 2005; 171: 388-416) or CAP. Clinical features on admission, rate of resolution of pneumonia findings, frequency of compliance with CAP therapy recommendations, length of stay and mortality were evaluated. Differences in groups were evaluated for statistical significance by the rank-sum test for continuous variables and Fisher's exact test for binary variables.
RESULTS: 40 patients had HCAP because of : admission from extended care facilities (n=20), recent hospitalization (n=12), and dialysis or other factors (n=8). The 40 patients with HCAP, compared to the 110 patients with CAP were significantly different ( p<0.05) with regard to : age (78.1+13.8 vs. 71.1+ 15.0), respiratory rate (25.2+7.6 vs. 22.2+5.2), CURB-65 score (2.3+1.2 vs. 1.7+1.0), PSI score (120.2+36.9 vs. 95.9+31.8), mortality (27.5% vs. 8.2%), length of stay (9.8 vs. 7.8 days), adherence to CAP guideline recommendations (55.0% vs. 81.8%), and incidence of confusion (23.7% vs. 8.3%). There were no differences in frequency of hypotension, leukocytosis, fever, need for ICU care or in the rate of resolution of pneumonia findings.
CONCLUSION: Patients with HCAP have a worse outcome (mortality and length of stay) than patients with CAP. This can be explained by higher severity of illness (CURB-65 and PSI) on admission, and possibly differences in therapy. More HCAP than CAP patients received therapy not adhering to CAP guidelines. This may represent recognition that such therapy would be inappropriate for HCAP patients.
CLINICAL IMPLICATIONS: We conclude that the optimal therapy to improve outcomes in HCAP patients still needs to be defined.
DISCLOSURE: Kumiko Hiramatsu, None.