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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.

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