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Original Research |

A Case-Control Study Assessing the Impact of Non-Ventilated Hospital- Acquired Pneumonia on Patient Outcomes

Scott T. Micek, PharmD; Bethany Chew; Nicholas Hampton, PharmD; Marin H. Kollef, MD
Author and Funding Information

Conflicts of Interest/Funding Information: Dr. Kollef's effort was supported by the Barnes-Jewish Hospital Foundation. Dr. Micek’s effort was supported by a research grant from Sage Products, LLC.

Corresponding Author: Scott T. Micek, PharmD St. Louis College of Pharmacy 4588 Parkview Place St. Louis, Missouri 63110-1088 Office: 314-446-8435 Fax: 314-454-5571.


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2016. doi:10.1016/j.chest.2016.04.009
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Abstract

Background  Non-ventilated hospital-acquired pneumonia (NVHAP) is a serious nosocomial infection increasingly attributed to antibiotic-resistant bacteria.

Methods  A retrospective case-control study comparing patients with and without NVHAP from 1 January 2014 to 31 December 2014 at Barnes-Jewish Hospital, a 1300-bed urban academic medical center in St. Louis, Missouri.

Results  174 consecutive patients with NVHAP were enrolled. A random sample of 696 control patients matched on age, gender, race, and hospital admission date were selected from a total of 5322 potential matched controls. NVHAP was pathogen-negative in 98 cases (56.3%). Respiratory viruses were identified in 42 (24.1%) patients, Gram-negative bacteria in 25 (14.4%) patients, and Gram-positive bacteria in 20 (11.5%) patients. Individuals developing NVHAP were more likely to die (15.5% versus 1.6%; P < 0.01), require intensive care (56.3% versus 22.8%; P < 0.01), mechanical ventilation (19.0% versus 3.9%; P < 0.01), and to have longer hospital length of stay (15.9 days [9.8 days, 26.3 days] versus 4.4 days [2.9 days, 7.3 days]; P < 0.01). The case-control study identified a strong association between hospital mortality and NVHAP, with NVHAP patients having an 8.4 times greater odds of death (95% CI, 5.6 – 12.5).

Conclusions  The occurrence of NVHAP was associated with significant increases in mortality, the use of intensive care, mechanical ventilation, and hospital length of stay. We also found that respiratory viruses were an important etiology of NVHAP. These findings suggest that efforts aimed at the successful prevention of NVHAP could improve patient outcomes and reduce health care costs.


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