Comparison of clinical characteristics between healthcare-associated pneumonia and community-acquired pneumonia in patients admitted to secondary hospitals
Braz. j. infect. dis
;
16(4): 321-328, July-Aug. 2012. ilus, tab
Article
Dans Anglais
| LILACS
| ID: lil-645419
ABSTRACT
BACKGROUND:
Since healthcare-associated pneumonia (HCAP) is heterogeneous, clinical characteristics and outcomes are different from region to region. There can also be differences between HCAP patients hospitalized in secondary or tertiary hospitals. This study aimed to evaluate the clinical characteristics of HCAP patients admitted into secondary community hospitals.METHODS:
This was a retrospective study conducted in patients with HCAP or community-acquired pneumonia (CAP) hospitalized in two secondary hospitals between March 2009 and January 2011.RESULTS:
Of a total of 303 patients, 96 (31.7%) had HCAP. 42 patients (43.7%) resided in a nursing home or long-term care facility, 36 (37.5%) were hospitalized in an acute care hospital for > 2 days within 90 days, ten received outpatient intravenous therapy, and eight attended a hospital clinic or dialysis center. HCAP patients were older. The rates of patients with CURB65 scores of 3 or more (22.9% vs. 9.1%; p = 0.001) and PSI class IV or more (82.2% vs. 34.7%; p < 0.001) were higher in the HCAP group. Drug-resistant pathogens were more frequently detected in the HCAP group (23.9% vs. 0.4%; p < 0.001). However, Streptococcus pneumoniae was the most common pathogen in both groups. The rates of antibiotic change, use of inappropriate antibiotics, and failure of initial antibiotic therapy in the HCAP group were significantly higher. Although the overall survival rate of the HCAP group was significantly lower (82.3% vs. 96.8%; p < 0.001), multivariate analyses failed to show that HCAP itself was a prognostic factor for mortality (p = 0.826). Only PSI class IV or more was associated with increased mortality (p = 0.005).CONCLUSIONS:
HCAP should be distinguished from CAP because of the different clinical features. However, the current definition of HCAP does not appear to be a prognostic for death. In addition, the use of broad-spectrum antibiotics for HCAP should be reassessed because S. pneumoniae was most frequently identified even in HCAP patients.
Texte intégral:
Disponible
Indice:
LILAS (Amériques)
Sujet Principal:
Infection croisée
/
Pneumopathie bactérienne
Type d'étude:
Etude d'étiologie
/
Étude observationnelle
/
Étude pronostique
/
Facteurs de risque
Limites du sujet:
Adulte très âgé
/
Aged80
/
Femelle
/
Humains
/
Mâle
Pays comme sujet:
Asie
langue:
Anglais
Texte intégral:
Braz. j. infect. dis
Thème du journal:
Maladies transmissibles
Année:
2012
Type:
Article
Pays d'affiliation:
Corée du Sud
Institution/Pays d'affiliation:
Jeju National University/KR
/
Kyung Hee University/KR
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