Clinical characteristics of health care-associated pneumonia in a Korean teaching hospital

Park, Hye Kyeong; Song, Jae-Uk; Um, Sang‐Won; Koh, Won‐Jung; Suh, Gee Young; Chung, Man Pyo; Kim, Hojoong; Kwon, O Jung; Jeon, Kyeongman

doi:10.1016/j.rmed.2010.06.009

Cited by 63 publications

(78 citation statements)

References 19 publications

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“…The three most widely studied criteria for severe pneumonia are the 20-variable Pneumonia Severity Index 20 , the 5-variable CURB-65 score the score is an acronym for each of the risk factors : Confusion, Urea 7 mmol / L, Respiratory rate ≥ 30 / min, low blood pressure, and Age ≥ 65 21 , and the 8-variable IDSA / ATS criteria 6 . We analyzed this study in accordance with the 8-variable IDSA / ATS criteria 6 , which is reported to have similar prognostic power to the Pneumonia Severity Index 20 in HCAP patients 22 , and disease severity on admission was identi ed as a prognostic factor for mortality from HCAP, as previously reported 23 .…”

Section: Discussionmentioning

confidence: 81%

Etiology and Factors Contributing to Mortality in Healthcare-associated Pneumonia: A Single-center Study

Ishiguro¹,

Takayanagi²,

Gochi³

et al. 2013

Showa Univ J Med Sci

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: Factors contributing to mortality in healthcare-associated pneumonia HCAP have not been investigated fully. We reviewed the etiology and identi ed prognostic factors of HCAP in hospitalized patients. We conducted a retrospective study of 500 Japanese patients with HCAP to assess these factors, with special emphasis on microbial etiology. Patients with HCAP were older 73.4 11.4 years , more predominantly male 74.4 , and had more smoking history and comorbidity than did community-acquired pneumonia CAP patients. Microbes were identi ed in 52.8 of HCAP patients. The most frequent causative microbial agents were Streptococcus pneumoniae n 108, 21.6 , influenza virus n 47, 9.4 , and Pseudomonas aeruginosa n 40, 8.0 . Multiple drug-resistant MDR pathogens were more frequent in HCAP patients 9.8 than CAP patients. Overall, 47 HCAP patients 9.4 died, with mortality being higher in HCAP than CAP patients. The three leading causes of non-survival from HCAP were S. pneumoniae, in uenza virus, and P. aeruginosa. MDR pathogens accounted for 21.3 of non-survivors. Multivariate analysis revealed disease severity on admission and treatment failure of initial antibiotics as independent factors for 30-day mortality. Among patients with treatment failure of initial antibiotics, 29.9 had received appropriate antibiotics. The most frequent pathogens in HCAP were S. pneumoniae, in uenza virus, and P. aeruginosa, in both survivors and nonsurvivors. Disease severity on admission and treatment failure of initial antibiotics were independent factors for mortality. MDR pathogens are important therapeutic targets to mitigate negative results, and treatment strategies other than antibiotic selection are also required.

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Section: Discussionmentioning

confidence: 81%

Etiology and Factors Contributing to Mortality in Healthcare-associated Pneumonia: A Single-center Study

Ishiguro¹,

Takayanagi²,

Gochi³

et al. 2013

Showa Univ J Med Sci

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“…First, in a Spanish study comparing HCAP and CAP patients with bacteraemic pneumococcal pneumonia, it was shown that despite low rates of inappropriate antibiotic therapy, mortality rates remained significantly higher in HCAP patients [13]. Secondly, in a Korean study, severity of illness, rather than type of pneumonia, was the main predicting factor for in-hospital mortality among patients with pneumonia hospitalised through the emergency department, despite a higher incidence of MDR in HCAP patients than CAP patients (29% versus 13%) [7]. Thirdly, in a large cohort study from 10 European countries including 119,699 patients admitted to the intensive care unit (ICU) for .2 days, excess risk of death for HCAP in the fully adjusted model ranged from 1.7 (95% CI 1.4-1.9) for drug-sensitive Staphylococcus aureus to 3.5 (2.9-4.2) for drug-resistant Pseudomonas aeruginosa.…”

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confidence: 94%

“…To date, eight studies specifically addressing HCAP have been published, including six retrospective [2][3][4][5][6][7] and two prospective studies [8,9], overall summing up to 2,056 patients. One study [8] has recently been extended to 557 patients [10].…”

mentioning

confidence: 99%

“…Only two studies originated from Europe [8,9]. All studies reported excess mortality of HCAP compared to community-acquired pneumonia (CAP) patients and five studies addressed the relationship of receiving inadequate initial antimicrobial treatment due to the presence of MDR pathogens [2,4,[7][8][9]. However, none convincingly established a relationship between inadequate treatment and excess mortality.…”

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confidence: 99%

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Healthcare-associated pneumonia: meeting the yeti

Ewig

Torres

2011

Eur Respir J

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“…Several studies have reported conflicting data on the frequency of multidrug-resistant bacteria [6,7,8,9,10,11]. Although patients who meet the criteria of HCAP are more susceptible to infection by drug-resistant pathogens, the majority of patients diagnosed with HCAP are not truly infected [6,7,8,9,10,11,12].…”

Section: Introductionmentioning

confidence: 99%

Risk Factors for Acquiring Potentially Drug-Resistant Pathogens in Immunocompetent Patients with Pneumonia Developed Out of Hospital

Jeong

Koh²,

Yoo³

et al. 2014

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Background: The concept of healthcare-associated pneumonia (HCAP) exists to identify patients infected with highly resistant pathogens who are exposed to the healthcare environment. However, many studies have included immunosuppressed patients who were excluded from the original concept. Objectives: The risk factors of potentially drug-resistant (PDR) pathogens in patients with pneumonia developed outside the hospital were reevaluated after excluding the patients who had immunosuppression. Methods: This was a retrospective study of prospectively collected data from all consecutive patients with pneumonia who were admitted to hospital via the emergency department between January 2008 and December 2011. Results: Pathogens were isolated in a total of 315 patients with pneumonia from our cohort; 33% with PDR pathogens did not meet the criteria for HCAP, but 44% without PDR pathogens did meet the criteria. Variables independently associated with PDR included nursing home residency, hospitalization in the preceding 90 days, antibiotics in the 30 days prior to pneumonia, poor function status and chronic lung disease. The new predictive scoring system based on the logistic regression model had a higher predictive power for the risk of PDR pathogens than the presence of the risk factors or the HCAP criteria. Conclusions: Functional status, pulmonary comorbidity and previous exposure to the healthcare environment were significantly associated with acquiring PDR pathogens in immunocompetent patients with pneumonia that developed out of hospital. However, a risk stratification model was more accurate than the presence of the risk factors or the HCAP criteria for assessing the probability of PDR pathogens.

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Clinical characteristics of health care-associated pneumonia in a Korean teaching hospital

Abstract: Severity of illness, rather than type of pneumonia, was the main predicting factor for in-hospital mortality among patients with pneumonia hospitalized through the emergency department.

Cited by 63 publications

References 19 publications

Etiology and Factors Contributing to Mortality in Healthcare-associated Pneumonia: A Single-center Study

Etiology and Factors Contributing to Mortality in Healthcare-associated Pneumonia: A Single-center Study

Healthcare-associated pneumonia: meeting the yeti

Risk Factors for Acquiring Potentially Drug-Resistant Pathogens in Immunocompetent Patients with Pneumonia Developed Out of Hospital

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