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Original Research: Chest Infections |

Pneumonia Pathogen Characterization Is an Independent Determinant of Hospital ReadmissionPathogen Characterization Hospital Readmission

Adam Andruska, MD; Scott T. Micek, PharmD; Yuichiro Shindo, MD; Nicholas Hampton, PharmD; Brian Colona, BS; Sandra McCormick, MSCIS; Marin H. Kollef, MD, FCCP
Author and Funding Information

From the Division of Pulmonary and Critical Care Medicine (Drs Andruska, Shindo, and Kollef), Washington University School of Medicine, St. Louis, MO; the St. Louis College of Pharmacy (Dr Micek), St. Louis, MO; the Institute for Advanced Research (Dr Shindo), Nagoya University, Nagoya, Japan; and BJC Healthcare (Dr Hampton, Mr Colona, and Ms McCormick), Center for Clinical Excellence, St. Louis, MO.

CORRESPONDENCE TO: Marin H. Kollef, MD, FCCP, Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, 660 S Euclid Ave, Campus Box 8052, St. Louis, MO 63110; e-mail: mkollef@dom.wustl.edu


FOR EDITORIAL COMMENT SEE PAGE 4

FUNDING/SUPPORT: The authors have reported to CHEST that no funding was received for this study.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2015;148(1):103-111. doi:10.1378/chest.14-2129
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BACKGROUND:  Hospital readmissions for pneumonia occur often and are difficult to predict. For fiscal year 2013, the Centers for Medicare & Medicaid Services readmission penalties have been applied to acute myocardial infarction, heart failure, and pneumonia. However, the overall impact of pneumonia pathogen characterization on hospital readmission is undefined.

METHODS:  This was a retrospective 6-year cohort study (August 2007 to September 2013).

RESULTS:  We evaluated 9,624 patients with a discharge diagnosis of pneumonia. Among these patients, 4,432 (46.1%) were classified as having culture-negative pneumonia, 1,940 (20.2%) as having pneumonia caused by antibiotic-susceptible bacteria, 2,991 (31.1%) as having pneumonia caused by potentially antibiotic-resistant bacteria, and 261 (2.7%) as having viral pneumonia. The 90-day hospital readmission rate for survivors (n = 7,637, 79.4%) was greatest for patients with pneumonia attributed to potentially antibiotic-resistant bacteria (11.4%) followed by viral pneumonia (8.3%), pneumonia attributed to antibiotic-susceptible bacteria (6.6%), and culture-negative pneumonia (5.8%) (P < .001). Multiple logistic regression analysis identified pneumonia attributed to potentially antibiotic-resistant bacteria to be independently associated with 90-day readmission (OR, 1.75; 95% CI, 1.56-1.97; P < .001). Other independent predictors of 90-day readmission were Charlson comorbidity score > 4, cirrhosis, and chronic kidney disease. Culture-negative pneumonia was independently associated with lower risk for 90-day readmission.

CONCLUSIONS:  Readmission after hospitalization for pneumonia is relatively common and is related to pneumonia pathogen characterization. Pneumonia attributed to potentially antibiotic-resistant bacteria is associated with an increased risk for 90-day readmission, whereas culture-negative pneumonia is associated with lower risk for 90-day readmission.

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