Why mortality is increased in health-care-associated pneumonia: lessons from pneumococcal bacteremic pneumonia

Chest
Jordi RelloPROCORNEU Study Group

Abstract

A cohort of patients with bacteremic Streptococcus pneumoniae pneumonia was reviewed to assess why mortality is higher in health-care-associated pneumonia (HCAP) than in community-acquired pneumonia (CAP). A prospective cohort of all adult patients with bacteremic pneumococcal pneumonia attended at the ED was used. One hundred eighty-four cases were classified as CAP and 44 (19%) as HCAP. Fifty-two (23%) were admitted to the ICU. Three (1.5%) isolates were resistant to beta-lactams, and only two patients received inappropriate therapy. The CAP cohort was significantly younger (median age 68 years, interquartile range [IQR] 42-78 vs 77 years, IQR 67-82, P < .001). The HCAP cohort presented a higher Charlson index (2.81 +/- 1.9 vs 1.23 +/- 1.42, P < .001) and had higher severity of illness at admission (altered mental status, respiratory rate > 30/min, Pao(2)/Fio(2) < 250, and multilobar involvement). HCAP patients had a lower rate of ICU admission (11.3% vs 25.5%, P < .05), and a trend toward lower mechanical ventilation (9% vs 19%, P = .17) and vasopressor use (9% vs 18.4%, P = .17) were documented. More patients in the HCAP cohort presented with a pneumonia severity index score > 90 (class IV-V, 95% vs 65%, P < .001), and 30-d...Continue Reading

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Related Concepts

Age Factors
Bacteriocidal Agents
Care of Intensive Care Unit Patient
Infections, Hospital
Lung
Pneumococcal Infections
Experimental Lung Inflammation
Mechanical Ventilation
Retrospective Studies
Severity of Illness Index

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