A Worldwide Perspective of Nursing Home-Acquired Pneumonia Compared With Community-Acquired Pneumonia

Abstract

the Community-Acquired Pneumonia Organization (CAPO) Investigators BACKGROUND: Nursing home-acquired pneumonia (NHAP) is the leading cause of death among long-term care patients and the second most common cause of transfers to acute care facilities. The aim of this study was to characterize the incidence, microbiology, and outcomes for hospitalized patients with community-acquired pneumonia (CAP) and NHAP. METHODS: A secondary analysis of 5,160 patients from the Community-Acquired Pneumonia Organization database was performed. World regions were defined as the United States and Canada (I), Latin America (II), and Europe (III). RESULTS: From a total of 5,160 hospitalized patients with CAP, NHAP was identified in 287 (5.6%) patients. Mean age was 80 y. NHAP distribution by region was 6% in region I, 3% in region II, and 7% in region III. Subjects with NHAP had higher frequencies of neurological disease, diabetes mellitus, congestive heart failure, and renal failure than did subjects with CAP (P < .001). ICU admission was required in 32 (12%) subjects. Etiology was defined in 68 (23%) subjects with NHAP and 1,300 (27%) with CAP. The most common pathogens identified in NHAP included Streptococcus pneumoniae (31%), Staphylococcus species (31%), and Pseudomonas aeruginosa (7%). Presentation of NHAP more frequently included pleural effusions (34% vs 21%, P < .001) and multilobar involvement (31% vs 24%, P < .001). Thirty-day hospital mortality was statistically greater among subjects with NHAP than among those with CAP (42% vs 18%, P < .001). CONCLUSIONS: Worldwide, only a very small proportion of hospitalized patients with CAP present with NHAP; the poor outcomes for these patients may be due primarily to a higher number of comorbidities compared with patients without NHAP.

Antimicrobial Resistance and Clinical Outcomes in Nursing Home-Acquired Pneumonia, Compared to Community-Acquired Pneumonia

“…However, treating NHAP and HCAP has been controversial, although the mortality rate of NHAP is higher than that of community-acquired pneumonia (CAP). The microbial distributions of NHAP vary among nations, regions, study designs, and disease severity 7. The British Thoracic Society guidelines for CAP in 2009 mentioned nursing home residents as a specific population group of CAP and did not recommend specific management for NHAP, in contrast to the 2005 ATS/IDSA guidelines 8.…”

The presence of COPD does not influence clinical outcomes in hospitalized patients with community-acquired pneumonia.

“…6 Similar results were found by Liapikou et al and Dusemund et al where inhospital mortality was similar for both groups. 7,15 On the other hand, in an observational study of 710 in which all patients underwent spirometry, COPD was independently associated with an increased risk of 30-day mortality (odds ratio = 2.62 [95% CI: 1.08-6.39]). 16 In our study, patients with COPD were older and had more comorbidities such as decompensated heart failure, renal disease, and diabetes.…”

Oral care measures for preventing nursing home-acquired pneumonia

“…The incidence of community-acquired pneumonia (CAP) requiring hospitalisation is 1.96 to 10 times higher amongst elderly nursing home residents than community-dwelling elderly people (Marrie 2002;Ronald 2008;Ticinesi 2016), with a 2.29 times higher rate of 30-day mortality (Liapikou 2014). This may be attributable to the particular characteristics of residents of nursing homes and long-term care facilities, as they tend to be older, to have greater functional impairment and to have increased comorbidities, polypharmacy and dependence upon caregivers (Dudas 2000;Martínez-Moragón 2004).…”

“…Gramnegative bacilli (GNB), such as Pseudomonas aeruginosa, Klebsiella pneumoniae and Enterobacter spp., have been suspected as causative pathogens of pneumonia (Craven 1992;Liapikou 2014). Dependent and frail elderly patients have a higher detection rate of GNB in their oropharyngeal cavities (Leibovitz 2003;Mylotte 1994;Palmer 2001).…”