Why mortality is increased in Healthcare-associated Pneumonia: lessons from pneumococcal bacteremic pneumonia.

Link to article at PubMed

Why mortality is increased in Healthcare-associated Pneumonia: lessons from pneumococcal bacteremic pneumonia.

Chest. 2009 Dec 1;

Authors: Rello J, Luján M, Gallego M, Valles J, Belmonte Y, Fontanals D, Diaz E, Lisboa T,

BACKGROUND: A cohort of patients with bacteremic Streptococcus pneumoniae pneumonia was reviewed to assess why mortality is higher in healthcare-associated pneumonia(HCAP) than in community-acquired pneumonia(CAP). METHODS: Prospective cohort of all adult patients with bacteremic pneumococcal pneumonia attended at the emergency department. RESULTS: One hundred and eighty-four cases were classified as CAP and 44 (19%) as HCAP. Fifty-two(23%) were admitted to the ICU. Three (1.5%) isolates were resistant to beta-lactams and only two patients received inappropriate therapy. The CAP cohort was significantly younger (median age 68 years old -IQR 42-78- vs 77 -67-82, p<0.001). The HCAP cohort presented higher Charlson's index (2.81 +/- 1.9 vs 1.23 +/-1.42, p<0.001) and had higher severity-of-illness at admission (altered mental status, RR>30/min, PaO2/FiO2<250 and multilobar involvement). HCAP patients had a lower rate of ICU admission (11.3% vs 25.5 % p<0.05) and a trend towards lower mechanical ventilation (9% vs 19% p=0.17) and vasopressor use (9% vs 18.4% p=0.17) were documented. More patients in the HCAP cohort presented with PSI score > 90 (class IV-V, 95% vs 65%, p<0.001), and 30-day mortality was significantly higher (29.5% vs 7.6%, p<0.001). A multivariable regression logistic analysis adjusting for underlying conditions and variables related to severity-of-illness confirmed that HCAP is an independent variable associated with increased mortality (OR= 5.56 95%, CI 1.86 to 16.5). CONCLUSIONS: Pneumococcal HCAP presents excess mortality which is independent of bacterial susceptibility. Differences in outcomes were probably due to differences in age, comorbidities, and criteria for ICU admission rather than to therapeutic decisions.

PMID: 19952058 [PubMed - as supplied by publisher]

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