Antimicrobial Resistance and Clinical Outcomes in Nursing Home-Acquired Pneumonia, Compared to Community-Acquired Pneumonia
1
조회
0
다운로드
4
인용
0
참고문헌
키워드
초록
Purpose: Patients with nursing home-acquired pneumonia (NHAP) should be treated as hospital-acquired pneumonia (HAP) accordingto guidelines published in 2005. However, controversy still exists on whether the high mortality of NHAP results from multidrugresistant pathogens or underlying disease. We aimed to outline differences and factors contributing to mortality betweenNHAP and community-acquired pneumonia (CAP) patients. Materials and Methods: We retrospectively evaluated patients aged 65 years or older with either CAP or NHAP from 2008 to 2014. Patients with healthcare-associated pneumonia other than NHAP or HAP were excluded. Results: Among 317 patients, 212 patients had CAP and 105 had NHAP. Patients with NHAP had higher mortality, more frequentlyused a ventilator, and had disease of higher severity than CAP. The incidences of aspiration, tube feeding, and poor functional statuswere higher in NHAP. Twenty three out of 54 NHAP patients and three out of 62 CAP patients had multidrug resistant pathogens(p<0.001). Eleven patients with NHAP died at discharge, compared to 7 patients with CAP (p=0.009). However, there was noassociation between mortality rate and presence of multidrug-resistant pathogens. The number of involved lobes on chest X-ray[odds ratio (OR)=1.708; 95% confidence interval (CI), 1.120 to 2.605] and use of mechanical ventilation (OR=9.537; 95% CI, 1.635 to55.632) were significantly associated with in-hospital mortality. Conclusion: Patients with NHAP had higher mortality than patients with CAP. The excess mortality among patients with NHAPand CAP was related to disease severity but not to the presence of multidrug resistant pathogens.
Abstract
Purpose: Patients with nursing home-acquired pneumonia (NHAP) should be treated as hospital-acquired pneumonia (HAP) accordingto guidelines published in 2005. However, controversy still exists on whether the high mortality of NHAP results from multidrugresistant pathogens or underlying disease. We aimed to outline differences and factors contributing to mortality betweenNHAP and community-acquired pneumonia (CAP) patients. Materials and Methods: We retrospectively evaluated patients aged 65 years or older with either CAP or NHAP from 2008 to 2014. Patients with healthcare-associated pneumonia other than NHAP or HAP were excluded. Results: Among 317 patients, 212 patients had CAP and 105 had NHAP. Patients with NHAP had higher mortality, more frequentlyused a ventilator, and had disease of higher severity than CAP. The incidences of aspiration, tube feeding, and poor functional statuswere higher in NHAP. Twenty three out of 54 NHAP patients and three out of 62 CAP patients had multidrug resistant pathogens(p<0.001). Eleven patients with NHAP died at discharge, compared to 7 patients with CAP (p=0.009). However, there was noassociation between mortality rate and presence of multidrug-resistant pathogens. The number of involved lobes on chest X-ray[odds ratio (OR)=1.708; 95% confidence interval (CI), 1.120 to 2.605] and use of mechanical ventilation (OR=9.537; 95% CI, 1.635 to55.632) were significantly associated with in-hospital mortality. Conclusion: Patients with NHAP had higher mortality than patients with CAP. The excess mortality among patients with NHAPand CAP was related to disease severity but not to the presence of multidrug resistant pathogens.
참고문헌 (27)
- Furman CD, "Pneumonia in older residents of long-term care facilities", Am Fam Physician, 70, pp.1495~1500 (2004)
- "2014 Statistics for ageing population in Korea" (2014)[URL]
- A study on the reinforcing medical service linkage between nursing home facilities and health care institutes, "Kim JS", Korea Institute for Health and Social Affairs, ~ (2013)
- Muder RR, "Nursing home-acquired pneumonia: an emergency department treatment algorithm", Curr Med Res Opin, 20, pp.1309~1320 (2004)
- Gruneir A, "Frequency and pattern of emergency department visits by long-term care residents--a population-based study. Frequency and pattern of emergency department visits by long-term care residents--a population-based study", J Am Geriatr Soc, 58, pp.510~517 (2010)
- American Thoracic Society, "Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia", Am J Respir Crit Care Med, 171, pp.388~416 (2005)
- Liapikou A, "A worldwide perspective of nursing home-acquired pneumonia compared with community-acquired pneumonia", Respir Care, 59, pp.1078~1085 (2014)
- Lim WS, "BTS guidelines for the management of community acquired pneumonia in adults: update 2009", Thorax, 64(Suppl 3), pp.iii1~iii55 (2009)
- Dhawan N, "Predictors of mortality for nursing home-acquired pneumonia:a systematic review", Biomed Res Int, 2015, pp.285983~ (2015)
- Ewig S, "Nursing-home-acquired pneumonia in Germany: an 8-year prospective multicentre study", Thorax, 67, pp.132~138 (2012)
- British Thoracic Society Standards of Care Committee, "BTS Guidelines for the Management of Community Acquired Pneumonia in Adults", Thorax, 56(Suppl 4), pp.IV1~IV64 (2001)
- Shindo Y, "Health-care-associated pneumonia among hospitalized patients in a Japanese community hospital", Chest, 135, pp.633~640 (2009)
- Yamaya M, "Interventions to prevent pneumonia among older adults", J Am Geriatr Soc, 49, pp.85~90 (2001)
- Klapdor B, "Presentation, etiology and outcome of pneumonia in younger nursing home residents", J Infect, 65, pp.32~38 (2012)
- Klapdor B, "Community-acquired pneumonia in younger patients is an entity on its own", Eur Respir J, 39, pp.1156~1161 (2012)
- El Solh AA, "Effect of antibiotic guidelines on outcomes of hospitalized patients with nursing home-acquired pneumonia", J Am Geriatr Soc, 57, pp.1030~1035 (2009)
- Polverino E, "Nursing home-acquired pneumonia: a 10 year singlecentre experience", Thorax, 65, pp.354~359 (2010)
- Lim WS, "A prospective comparison of nursing home acquired pneumonia with community acquired pneumonia", Eur Respir J, 18, pp.362~368 (2001)
- 고성주, "Clinical characteristics of nursing home-acquired pneumonia in elderly patients admitted to a Korean teaching hospital", The Korean Journal of Internal Medicine, 30(5), pp.638~647 (2015), 대한내과학회[DOI]
- El-Solh AA, "Etiology of severe pneumonia in the very elderly", Am J Respir Crit Care Med, 163(3Pt 1), pp.645~651 (2001)
- Ma HM, "Should nursing home-acquired pneumonia be treated as nosocomial pneumonia?", J Am Med Dir Assoc, 13, pp.727~731 (2012)
- Ugajin M, "Prognostic value of severity indicators of nursing-home-acquired pneumonia versus community-acquired pneumonia in elderly patients", Clin Interv Aging, 9, pp.267~274 (2014)
- Young-Jae Cho, "A Comparative Study of Nursing Home-Acquired Pneumonia with Community-Acquired Pneumonia", Tuberculosis and Respiratory Diseases, 70(3), pp.224~234 (2011), 대한결핵및호흡기학회
- Chalmers JD, "Healthcare-associated pneumonia does not accurately identify potentially resistant pathogens:a systematic review and meta-analysis", Clin Infect Dis, 58, pp.330~339 (2014)
- Micek ST, "Health care-associated pneumonia and community-acquired pneumonia:a single-center experience", Antimicrob Agents Chemother, 51, pp.3568~3573 (2007)
- Kollef MH, "Epidemiology and outcomes of health-care-associated pneumonia: results from a large US database of culture-positive pneumonia", Chest, 128, pp.3854~3862 (2005)
- Lee JC, "Comparison of severity predictive rules for hospitalised nursing home-acquired pneumonia in Korea: a retrospective observational study", Prim Care Respir J, 22, pp.149~154 (2013)