Prognostic value of severity indicators of nursing-home-acquired pneumonia versus community-acquired pneumonia in elderly patients

Ugajin, Motoi; Yamaki, Kenichi; Hirasawa, Natsuko; Kobayashi, Takanori; Yagi, Takeo

doi:10.2147/cia.s58682

Cited by 26 publications

(39 citation statements)

References 33 publications

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“…Several studies have demonstrated the usefulness of CURB65 in NHAP and HCAP [12][13][14] although it may show reduced discriminating ability as compared to its original use in CAP populations. This is demonstrated in our study by a nonsignificant inferior CURB65 ROC AUC comparison result between NHAP and CAP groups derived from the same original cohort [9].…”

Section: Discussionmentioning

confidence: 99%

Nursing home-acquired pneumonia presenting at the emergency department

2016

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Nursing home-acquired pneumonia (NHAP) is one of the most common infections arising amongst nursing home residents, and its incidence is expected to increase as population ages. The NHAP recommendation for empiric broad-spectrum antibiotic therapy, arising from the concept of healthcare-associated pneumonia, has been challenged by recent studies reporting low rates of multidrug-resistant (MDR) bacteria. This single center study analyzes the results of NHAP patients admitted through the Emergency Department (ED) at a tertiary center during the year 2010. There were 116 cases, male gender corresponded to 34.5 % of patients and median age was 84 years old . Comorbidities were present in 69.8 % of cases and 48.3 % of patients had used healthcare services during the previous 90 days. In-hospital mortality rate was 46.6 % and median length-of-stay was 9 days. Severity assessment at the Emergency Department provided CURB65 index score and respective mortality (%) results: zero: n = 0; one: n = 7 (0 %); two: n = 18 (38.9 %); three: n = 26 (38.5 %); four: n = 30 (53.3 %); and five; n = 22 (68.2 %); and sepsis n = 50 (34.0 %), severe sepsis n = 43 (48.8 %) and septic shock n = 22 (72.7 %). Significant risk factors for in-hospital mortality in multivariate analysis were polypnea (p = 0.001), age C 75 years (p = 0.02), and severe sepsis or shock (p = 0.03) at the ED. Microbiological testing in 78.4 % of cases was positive in 15.4 % (n = 15): methicillinresistant Staphylococcus aureus (26.7 %), Pseudomonas aeruginosa (20.0 %), S. pneumoniae (13.3 %), Escherichia coli (13.3 %), others (26.7 %); the rate of MDR bacteria was 53.3 %. This study reveals high rates of mortality and MDR bacteria among NHAP hospital admissions supporting the use of empirical broad-spectrum antibiotic therapy in these patients.

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Section: Discussionmentioning

confidence: 99%

Nursing home-acquired pneumonia presenting at the emergency department

2016

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“…Nineteen articles were potentially eligible after screening the titles and abstracts, 11 of which were excluded after reviewing the full texts, leaving 8 articles eventually selected [7][8][9][10][14][15][16][17] . The flowchart for the selection process is shown in Figure 1 , and the characteristics of the included studies are shown in Table 1 .…”

Section: Included Studiesmentioning

confidence: 99%

“…The size of the included studies ranged from 74 to 767 patients, and the mortality rate ranged from 12.4 to 24.1%. Two of the 8 studies were prospective observational studies [8,15] , and the other 6 were retrospective observational studies [7,9,10,14,16,17] . Seven of the 8 studies described 30-day mortality [7][8][9][10][14][15][16] , while the other described 28-day mortality [17] as the study outcome.…”

Section: Included Studiesmentioning

confidence: 99%

“…Two of the 8 studies were prospective observational studies [8,15] , and the other 6 were retrospective observational studies [7,9,10,14,16,17] . Seven of the 8 studies described 30-day mortality [7][8][9][10][14][15][16] , while the other described 28-day mortality [17] as the study outcome. Four studies evaluated patients with HCAP [7][8][9][10] , and the rest studied patients with NHAP [14][15][16][17] .…”

Section: Included Studiesmentioning

confidence: 99%

“…Although various studies regarding severity assessment tools for HCAP patients have been reported thus far [7][8][9][10][14][15][16][17] , no specific severity assessment tools for predicting the mortality in patients with HCAP have been developed. Some reports have suggested that the PORT score and CURB-65 may be able to be used to predict the mortality in the management of patients with HCAP [7,9] ; however, the lack of usefulness of these scoring systems has also been reported, particularly with respect to predicting mortality in low risk classes [18] .…”

Section: Introductionmentioning

confidence: 99%

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Pneumonia Severity Assessment Tools for Predicting Mortality in Patients with Healthcare-Associated Pneumonia: A Systematic Review and Meta-Analysis

et al. 2017

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Background: In contrast to community-acquired pneumonia (CAP), no specific severity assessment tools have been developed for healthcare-associated pneumonia (HCAP) in clinical practice. Objectives: In this review, we assessed the clinical significance of severity assessment tools for HCAP. Methods: We identified related articles from the PubMed database. The eligibility criteria were original research articles evaluating severity scoring tools and reporting the outcomes of mortality in patients with HCAP. Results: Eight articles were included in the meta-analysis. The PORT score and CURB-65 were evaluated in 7 and 8 studies, respectively. Using cutoff values of ≥IV and V for the PORT score, the diagnostic odds ratios (DORs) were 5.28 (2.49-11.17) and 3.76 (2.88-4.92), respectively, and the areas under the curve (AUCs) were 0.68 (0.64-0.72) and 0.71 (0.67-0.75), respectively. Conversely, the AUCs for ≥IV and V were 0.71 (0.67-0.76) and 0.74 (0.70-0.78), respectively, when applied only to nonimmunocompromised patients. In contrast, when using cutoff values of ≥2 and ≥3 for CURB-65, the DORs were 3.35 (2.26-4.97) and 2.65 (2.05-3.43), respectively, and the AUCs were 0.65 (0.61-0.69) and 0.66 (0.62-0.70), respectively. Conversely, the AUCs for ≥2 and ≥3 were 0.65 (0.61-0.69) and 0.68 (0.64-0.72), respectively, when applied only to nonimmunocompromised patients. Conclusions: The PORT score and CURB-65 do not have substantial power compared with the tools for CAP patients, although the PORT score is more useful than CURB-65 for predicting mortality in HCAP patients. According to our results, however, these tools, especially the PORT score, can be more useful when limited to nonimmunocompromised patients.

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Impact of microbiological samples in the hospital management of community-acquired, nursing home-acquired and hospital-acquired pneumonia in older patients

Putot

Tetu

Perrin

et al. 2016

Eur J Clin Microbiol Infect Dis

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We investigated the positivity rate, the detection rates for non-covered pathogens and the therapeutic impact of microbiological samples (MS) in community-acquired pneumonia (CAP), nursing home-acquired pneumonia (NHAP) and hospital-acquired pneumonia (HAP) in elderly hospitalised patients. Patients aged 75 years and over with pneumonia and hospitalised between 1/1/2013 and 30/6/2013 in the departments of medicine (5) and intensive care (1) of our university hospital were included. Microbiological findings, intra-hospital mortality and one-year mortality were recorded. Among the 217 patients included, there were 138 CAP, 56 NHAP and 23 HAP. MS were performed in 89.9, 91.1 and 95.6 % of CAP, NHAP and HAP, respectively. Microbiological diagnosis was made for 29, 11.8 and 27.3 % of patients for CAP, NHAP and HAP, respectively (p = 0.05). Non-covered pathogens were detected for 8 % of CAP, 2 % of NHAP and 13.6 % of HAP (p = 0.1). The antimicrobial spectrum was significantly more frequently reduced when the MS were positive (46.7 % vs. 10.8 % when MS were negative, p = 10(-7)). The MS positivity rate was significantly lower in NHAP than in CAP and HAP. MS revealed non-covered pathogens in only 2 % of NHAP. These results show the poor efficiency and weak clinical impact of MS in the management of pneumonia in hospitalised older patients and suggest that their use should be rationalised.

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Prognostic value of severity indicators of nursing-home-acquired pneumonia versus community-acquired pneumonia in elderly patients

Cited by 26 publications

References 33 publications

Nursing home-acquired pneumonia presenting at the emergency department

Nursing home-acquired pneumonia presenting at the emergency department

Pneumonia Severity Assessment Tools for Predicting Mortality in Patients with Healthcare-Associated Pneumonia: A Systematic Review and Meta-Analysis

Impact of microbiological samples in the hospital management of community-acquired, nursing home-acquired and hospital-acquired pneumonia in older patients

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