You are seeing this message because your Web browser does not support basic Web standards. Find out more about why this message is appearing and what you can do to make your experience on this site better.


ABOUT ARCHIVES
Advanced Search

Welcome   | My Account | E-mail Alerts | Access Rights | Sign In


  Vol. 167 No. 13, July 9, 2007 TABLE OF CONTENTS
  Archives
  •  Online Features
  Original Investigation
 This Article
 •Full text
 •PDF
 •Send to a friend
 • Save in My Folder
 •Save to citation manager
 •Permissions
 Citing Articles
 •Citation map
 •Citing articles on HighWire
 •Citing articles on Web of Science (34)
 •Contact me when this article is cited
 Related Content
 •Related letters
 •Similar articles in this journal
 Topic Collections
 •Bacterial Infections
 •Infectious Diseases, Other
 •Prognosis/ Outcomes
 •Drug Therapy
 •Drug Therapy, Other
 •Infectious Diseases
 •Alert me on articles by topic
 Social Bookmarking
  Add to CiteULike Add to Connotea Add to Del.icio.us Add to Digg Add to Reddit Add to Technorati Add to Twitter What's this?

Health Care–Associated Pneumonia Requiring Hospital Admission

Epidemiology, Antibiotic Therapy, and Clinical Outcomes

Jordi Carratalà, MD, PhD; Analía Mykietiuk, MD; Núria Fernández-Sabé, MD, PhD; Cristina Suárez, MD; Jordi Dorca, MD, PhD; Ricard Verdaguer, MD; Frederic Manresa, MD, PhD; Francesc Gudiol, MD, PhD

Arch Intern Med. 2007;167(13):1393-1399.

Background  Health care–associated pneumonia (HCAP) has been proposed as a new category of respiratory infection. However, limited data exist to validate this entity. We aimed to ascertain the epidemiology, causative organisms, antibiotic susceptibilities, and outcomes of and empirical antibiotic therapy for HCAP requiring hospitalization.

Methods  Observational analysis of a prospective cohort of nonseverely immunosuppressed hospitalized adults with pneumonia. Patients who had recent contact with the health care system through nursing homes, home health care programs, hemodialysis clinics, or prior hospitalization were considered to have HCAP.

Results  Of 727 cases of pneumonia, 126 (17.3%) were HCAP and 601 (82.7%) were community acquired. Compared with patients with community-acquired pneumonia, patients with HCAP were older (mean age, 69.5 vs 63.7 years; P < .001), had greater comorbidity (95.2% vs 74.7%; P < .001), and were more commonly classified into high-risk pneumonia severity index classes (67.5% vs 48.8%; P < .001). The most common causative organism was Streptococcus pneumoniae in both groups (27.8% vs 33.9%). Drug-resistant pneumococci were more frequently encountered in cases of HCAP. Legionella pneumophila was less common in patients with HCAP (2.4% vs 8.8%; P = .01). Aspiration pneumonia (20.6% vs 3.0%; P < .001), Haemophilus influenzae (11.9% vs 6.0%; P = .02), Staphylococcus aureus (2.4% vs 0%; P = .005), and gram-negative bacilli (4.0% vs 1.0%; P = .03) were more frequent in HCAP. Patients with HCAP more frequently received an initial inappropriate empirical antibiotic therapy (5.6% vs 2.0%; P = .03). The overall case-fatality rate (< 30 days) was higher in patients with HCAP (10.3% vs 4.3%; P = .007).

Conclusions  At present, a substantial number of patients initially seen with pneumonia in the emergency department have HCAP. These patients require a targeted approach when selecting empirical antibiotic therapy.


Author Affiliations: Infectious Disease Service (Drs Carratalà, Mykietiuk, Fernández-Sabé, Suárez, and Gudiol), Respiratory Service (Drs Dorca and Manresa), and Microbiology Service (Dr Verdaguer), Institut d’Investigació Biomèdica de Bellvitge–Hospital Universitari de Bellvitge, University of Barcelona, L’Hospitalet, Barcelona, Spain.



Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Digg Digg   Add to Reddit Reddit   Add to Technorati Technorati   Add to Twitter Twitter     What's this?

RELATED LETTERS

Health Care–Associated Pneumonia: A New Clinical Entity
Marco Falcone, Pietro Serra, Giuseppe Licata, Mario Venditti, and for the Italian Society of Internal Medicine (SIMI)
Arch Intern Med. 2008;168(1):109-110.
EXTRACT | FULL TEXT  

Risk Factors for Community-Acquired Infections Caused by Extended-Spectrum β-Lactamase–Producing Escherichia coli—Reply
Jesús Rodríguez-Baño and Alvaro Pascual
Arch Intern Med. 2009;169(8):811-812.
EXTRACT | FULL TEXT  


THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Meeting the old man's friend
Torres and Menendez
Thorax 2009;64:1016-1017.
FULL TEXT  

New perspectives on community-acquired pneumonia in 388 406 patients. Results from a nationwide mandatory performance measurement programme in healthcare quality
Ewig et al.
Thorax 2009;64:1062-1069.
ABSTRACT | FULL TEXT  

What is MRSA?
Pantosti and Venditti
Eur Respir J 2009;34:1190-1196.
ABSTRACT | FULL TEXT  

BTS guidelines for the management of community acquired pneumonia in adults: update 2009
Lim et al.
Thorax 2009;64:iii1-iii55.
FULL TEXT  

Quality pneumonia care: Distinguishing community-acquired from health care-associated pneumonia
Shorr and Owens
Am J Health Syst Pharm 2009;66:S8-S14.
ABSTRACT | FULL TEXT  

Risk Factors for Community-Acquired Infections Caused by Extended-Spectrum {beta}-Lactamase-Producing Escherichia coli--Reply
Rodriguez-Bano and Pascual
Arch Intern Med 2009;169:811-812.
FULL TEXT  

Health-Care-Associated Pneumonia: Not Just a US Phenomenon
Kollef
Chest 2009;135:594-596.
FULL TEXT  

Health-Care-Associated Pneumonia Among Hospitalized Patients in a Japanese Community Hospital
Shindo et al.
Chest 2009;135:633-640.
ABSTRACT | FULL TEXT  

Outcomes of Patients Hospitalized With Community-Acquired, Health Care-Associated, and Hospital-Acquired Pneumonia
Venditti et al.
ANN INTERN MED 2009;150:19-26.
ABSTRACT | FULL TEXT  

Prediction of Infection Due to Antibiotic-Resistant Bacteria by Select Risk Factors for Health Care-Associated Pneumonia
Shorr et al.
Arch Intern Med 2008;168:2205-2210.
ABSTRACT | FULL TEXT  

How can we improve the management and outcome of pneumonia in the elderly?
Brito and Niederman
Eur Respir J 2008;32:12-14.
FULL TEXT  

Outcome of community-acquired pneumonia: influence of age, residence status and antimicrobial treatment
Kothe et al.
Eur Respir J 2008;32:139-146.
ABSTRACT | FULL TEXT  

Health Care Associated Pneumonia: A New Clinical Entity
Falcone et al.
Arch Intern Med 2008;168:109-110.
FULL TEXT  

Pneumonia After Healthcare Exposure
JWatch Infect. Diseases 2007;2007:3-3.
FULL TEXT  





HOME | CURRENT ISSUE | PAST ISSUES | TOPIC COLLECTIONS | CME | SUBMIT | SUBSCRIBE | HELP
CONDITIONS OF USE | PRIVACY POLICY | CONTACT US | SITE MAP
 
© 2007 American Medical Association. All Rights Reserved.