Clinical characteristics and prognostic risk factors of healthcare-associated pneumonia in a Korean tertiary teaching hospital

Ahn, Jae‐Jun; Lee, Kwan H.; Chung, Jin Hong; Shin, Kyeong‐Cheol; Lee, Choong K.; Kim, Hyun Jung; Choi, Eun Young

doi:10.1097/md.0000000000008243

Cited by 15 publications

(17 citation statements)

References 22 publications

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“…Older age, ICU, and tracheal cannula were associated with higher mortality due to HAP, which is consistent with the finding of previous studies [ 15 – 17 ]. Although the CPIS has shown a low diagnostic performance in recent studies [ 18 , 19 ], CPIS ≥7 was a risk factor for mortality due to HAP in our study.…”

Section: Discussionsupporting

confidence: 92%

Clinical and microbiological characteristics of adults with hospital-acquired pneumonia: a 10-year prospective observational study in China

Yin

Zhao

et al. 2020

Eur J Clin Microbiol Infect Dis

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Hospital-acquired pneumonia (HAP) is a significant nosocomial infection; data on the distribution and antimicrobial resistance profiles of HAP in China are limited. We included 2827 adult patients with HAP from the Chinese Antimicrobial Resistance Surveillance of Nosocomial Infections network admitted in 15 Chinese teaching hospitals between 2007 and 2016. Clinical data and antimicrobial susceptibility of isolated pathogens were obtained from the medical records and central laboratory, respectively. Multivariable logistic regression was performed to determine the risk factors for mortality and multidrug resistance (MDR). A total of 386 (13.7%) patients died in the hospital, while 1181 (41.8%) developed ventilator-associated pneumonia (VAP). Active immunosuppressant therapy (OR 1.915 (95% CI 1.475-2.487)), solid tumor (OR 1.860 (95% CI 1.410-2.452)), coma (OR 1.783 (95% CI 1.364-2.333)), clinical pulmonary infection score ≥7 (OR 1.743 (95% CI 1.373-2.212)), intensive care unit stay (OR 1.652 (95% CI 1.292-2.111)), age ≥65 years (OR 1.621 (95% CI 1.282-2.049)), and tracheal cannula insertion (OR 1.613 (95% CI 1.169-2.224)) were independent risk factors for in-hospital mortality. Liver cirrhosis (OR 3.120 (95% CI 1.436-6.780)) and six other variables were independent predictors of MDR. Acinetobacter baumannii (25.6%), Pseudomonas aeruginosa (20.1%), Klebsiella pneumoniae (15.4%), and Staphylococcus aureus (12.6%) were the most common pathogens (MDR prevalence 64.9%). Isolates from VAP patients showed more A. baumannii and less K. pneumoniae and E. coli strains (p < 0.001, respectively) than those from patients without VAP. The proportion of methicillin-resistant S. aureus strains decreased; that of carbapenem-resistant A. baumannii and Enterobacterales strains increased. There had been changes in the antibiotic resistance profiles of HAP pathogens in China. Risk factors for mortality and MDR are important for the selection of antimicrobials for HAP in China.

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Section: Discussionsupporting

confidence: 92%

Clinical and microbiological characteristics of adults with hospital-acquired pneumonia: a 10-year prospective observational study in China

Yin

Zhao

et al. 2020

Eur J Clin Microbiol Infect Dis

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“…As reported previously 10 , identified pathogens that were not susceptible to β-lactams, macrolides, and fluoroquinolones were defined as multidrug-resistant (MDR) pathogens.…”

Section: Methodsmentioning

confidence: 99%

Expanded A-DROP Score: A New Scoring System for the Prediction of Mortality in Hospitalized Patients with Community-acquired Pneumonia

Ahn

Choi

2018

Sci Rep

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There are several established prognostic scoring systems for community-acquired pneumonia (CAP). The Pneumonia Severity Index (PSI) is a prediction rule consisting of 20 variables to identify low-risk patients with CAP. Although PSI had high discrimination ability, it is complex to calculate and difficult to use in busy hospital settings. The CURB-65 score is much simpler to use than is PSI, but it has lower sensitivity for predicting mortality compared with PSI. The A-DROP score is a modified version of the CURB-65 score and provides similar predictive power to that of CURB-65. This study was performed to determine whether a simpler score (CURB-65, A-DROP), expanded with a small number of additional variables, can predict mortality more accurately than PSI. We conducted a retrospective observational study of 1,031 patients with CAP who were hospitalized at a tertiary teaching hospital. We used age, sex, comorbidities, vital signs, and laboratory findings as prognostic variables. We compared the PSI, CURB-65, and A-DROP scores using receiver operating characteristic curve analysis. The areas under the curves (AUCs) of PSI, CURB-65, and A-DROP were 0.735, 0.701, and 0.730, respectively.Multivariable analysis identified malignancy [odds ratio (OR): 2.17, 95% confidence interval (CI): 1.13–4.17], respiration rate ≥ 24/min [OR: 2.18, 95% CI: 1.24–3.82], heart rate ≥ 100/min [OR: 2.92, 95% CI: 1.68–5.08], albumin ≤ 3.09 g/dL [OR: 3.85, 95% CI: 2.09–7.07], lactate > 1.7 mmol/L [OR: 2.59, 95% CI: 1.53–4.38], and N-terminal prohormone brain natriuretic peptide > 500 pg/mL [OR: 2.23, 95% CI: 1.26–3.95] as prognostic factors. Using the prognostic variables identified in the multivariable analysis, we assembled a new scoring system, the expanded A-DROP score. The AUC of this score for the prediction of 28-day mortality was 0.834 (95% CI: 0.794–0.874). Bootstrap validation yielded an estimated AUC of 0.833, indicating negligible overfitting of the model.The expanded A-DROP score is a relatively simple and effective scoring system, and its predictive value was superior to those of other scoring systems.

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“…One clinical report from an Asian tertiary teaching hospital showed that Klebsiella spp. and Streptococcus pneumoniae are two leading pathogens of healthcare-associated pneumonia (6). It has been reported that patients with K. pneumoniae chest infection frequently suffer a rapid, fatal outcome (7), and physicians should understand the clinical characteristics of Klebsiella chest infections; however, there have been no recent reports investigating how chest infections due to Klebsiella spp.…”

Section: Introductionmentioning

confidence: 99%

Comparison between Patients with Chest Infection due to <i>Klebsiella</i> spp. and <i>Streptococcus pneumoniae</i>

Ishiguro¹,

Uozumi

Yoshioka³

et al. 2020

Intern. Med.

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Objective In Japan, the aging demographic structure is becoming pronounced, and the full-blown graying of society appears not far off, which indicates an increasing population that will require healthcare contact. Klebsiella spp. are major pathogens in healthcare-associated infections, and their importance is increasing. The aim of this study was to clarify the characteristics of Klebsiella spp. chest infections by evaluating the differences in the characteristics of chest infections caused by Klebsiella spp. and pneumoniae. Methods We conducted a retrospective study of consecutive patients hospitalized with pneumonia, lung abscess/necrotizing pneumonia, and empyema due to Klebsiella spp. and S. pneumoniae for 15 years at our institution in Saitama, Japan. Patients Patients with chest infections due to Klebsiella spp. (K group, n=76) and S. pneumoniae (S group, n=446) were included. Results The K group more frequently was male, older, coinfected by Pseudomonas aeruginosa, and had diabetes mellitus, a history of upper digestive system surgery, alcohol drinking habit, a smoking habit, and an impaired premorbid performance status than the S group. The percentages of lung abscesses or necrotizing pneumonia (31.6% vs. 0.9%) and empyema without pulmonary parenchymal shadow (3.9% vs. 0.7%) were higher in the K group than those in the S group. Severity on admission and mortality did not differ between the groups; however, patients in the K group required a longer duration of antibiotics administration and hospital stay than those in the S group. Conclusion Klebsiella spp. chest infections have some marked characteristics when compared with pneumococcal infections, and our results serve to differentiate Klebsiella spp. infection from pneumococcal infection.

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Clinical characteristics and prognostic risk factors of healthcare-associated pneumonia in a Korean tertiary teaching hospital

Cited by 15 publications

References 22 publications

Clinical and microbiological characteristics of adults with hospital-acquired pneumonia: a 10-year prospective observational study in China

Clinical and microbiological characteristics of adults with hospital-acquired pneumonia: a 10-year prospective observational study in China

Expanded A-DROP Score: A New Scoring System for the Prediction of Mortality in Hospitalized Patients with Community-acquired Pneumonia

Comparison between Patients with Chest Infection due to <i>Klebsiella</i> spp. and <i>Streptococcus pneumoniae</i>

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