Incidence of Antibiotic Treatment Failure in Patients with Nursing Home-Acquired Pneumonia and Community Acquired Pneumonia

Abstract

Purpose: Nursing home-acquired pneumonia (NHAP) patients are at higher risk of multi-drug resistant infection (MDR) than those with community-acquired pneumonia (CAP). Recent evidence suggests a single risk factor for MDR does not accurately predict the need for broad-spectrum antibiotics. The goal of this study was to compare the rate antibiotic failure between NHAP and CAP patients. Methods: Demographic characteristics, co-morbidities, clinical and laboratory variables, antibiotic therapy, and mortality data were collected retrospectively for all patients with pneumonia admitted to an Internal Medicine Service between April 2017 and April 2018. Results: In total, 313 of 556 patients had CAP and 243 had NHAP. NHAP patients were older, and were more likely to be dependent, to have recent antibiotic use, and to experience treatment failure (odds ratio (OR) 1.583; 95% CI 1.102–2.276; p = 0.013). In multivariate analysis, patient’s origin did not predict treatment failure (OR 1.083; 95% CI 0.726–1.616; p = 0.696). Discussion: Higher rates of antibiotic failure and mortality in NHAP patients were explained by the presence of other risk factors such as comorbidities, more severe presentation, and age. Admission from a nursing home is not a sufficient condition to start broader-spectrum antibiotics.

Risk factor-based analysis of community-acquired pneumonia, healthcare-associated pneumonia and hospital-acquired pneumonia: Microbiological distribution, antibiotic resistance, and clinical outcomes

“…These criteria can be easily applied to clinical practice for the risk assessment of MDR bacterial infections. However, there are still many reports showing that the distribution of pathogens causing HCAP is different from that of CAP [ 6 – 8 ]. With increasing medical service use, along with an aging population, MDR pathogens are more likely to be prevalent.…”

Protein C activity as a potential prognostic factor for nursing home-acquired pneumonia

“…NHAP patients are known to show a higher mortality rate than CAP patients [ 4 – 11 ], but useful prognostic predictors for NHAP are lacking. Moreover, the prognostic predictors for CAP such as albumin or C-reactive protein [ 44 , 45 ] were not predictors for NHAP ( Table 3 ).…”

“…Many of them have to enter a nursing home [ 2 ], and pneumonia is one of the most common infections identified in nursing home residents [ 3 ]. Pneumonia occurring in nursing homes (Nursing home-acquired pneumonia, NHAP) has been considered to be distinct from community-acquired pneumonia (CAP) with unique epidemiological features and poor outcomes [ 4 – 11 ] since its proposal in 1978 [ 12 ]. The mortality of NHAP ranges from 6.5 to 40% [ 4 , 6 ], and it is as high as 18.1% in Japan [ 13 ].…”

Treatment Failure and Clinical Stability in Severe Community-Acquired Pneumonia

“…Several studies have evaluated risk factors for treatment failure in pneumonia. 9 23 24 25 26 27 The main risk factors include variables related to the host, initial severity, microbiology, radiological affectation, or empirical antimicrobial treatment ( Table 2 ). In a post hoc analysis from a randomized clinical trial in CAP evaluating the short course of antibiotic treatment in nonsevere patients with CS, Dinh et al evaluated risk factors related to treatment failure (in this case at day 15).…”