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Rates and Risk Factors for Recurrent Pneumonia in Patients Hospitalized with Community-Acquired Pneumonia: Population-Based Prospective Cohort Study with 5-Years of Follow-up.
Clin Infect Dis. 2014 Apr 11;
Authors: Dang TT, Eurich DT, Weir DL, Marrie TJ, Majumdar SR
Abstract
Background. Despite how common hospitalization for community-acquired pneumonia (CAP) is, the rates and risk factors for developing recurrent pneumonia following discharge are poorly understood, and so we undertook this study. Methods. We examined a population-based prospective cohort of patients with CAP who survived initial hospital admission and who were free of pneumonia for at least 3-months after discharge. At admission, we collected detailed clinical, functional status, and medication-related information and determined the Pneumonia Severity Index (PSI). Using linked healthcare databases we followed patients for up to 5-years and captured any clinical episode of pneumonia 90-days or more post-discharge. We used multivariable Cox proportional hazards models (adjusted for age, sex, PSI, functional status, medications) to determine rates and independent correlates of recurrent pneumonia. Results. The final cohort included 2709 inpatients; 43% were 75-years or older, 51% were male, 34% were not fully independent, and 56% had severe (PSI Class IV-V) pneumonia. Over 5-years of follow-up, 245 (9%, 95%CI 8-10) patients developed recurrent pneumonia, and 156 (64%) of these episodes required hospitalization. The rate of recurrence was 3.0 per 100 person-years and median time to recurrence was 317 days (IQR 177-569); 32 (13%) patients had 2 or more recurrences. Although patients with recurrent pneumonia had more comorbidities and more severe initial pneumonia, in multivariable analyses only age>75-years (adjusted p=0.047) and less than fully independent functional status (12% recurrence rate with impaired functional status vs. 7% for fully independent, adjusted HR 1.7, 95%CI 1.3-2.2, p<0.001) were significantly associated with recurrent pneumonia. Conclusions. One of 11 patients who survived CAP hospitalization had a recurrent episode of pneumonia over 5-years and older patients and those with impaired functional status were at particularly high-risk. Recurrent pneumonia is common and more attention to preventive strategies at discharge and closer follow-up over the long-term seem warranted.
PMID: 24729503 [PubMed - as supplied by publisher]