Yonsei Med J.  2017 Jan;58(1):180-186. 10.3349/ymj.2017.58.1.180.

Antimicrobial Resistance and Clinical Outcomes in Nursing Home-Acquired Pneumonia, Compared to Community-Acquired Pneumonia

Affiliations
  • 1Division of Pulmonary and Critical Care Medicine, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Korea. ysyoonmd@gmail.com
  • 2Department of Internal Medicine, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Korea.

Abstract

PURPOSE
Patients with nursing home-acquired pneumonia (NHAP) should be treated as hospital-acquired pneumonia (HAP) according to guidelines published in 2005. However, controversy still exists on whether the high mortality of NHAP results from multidrug resistant pathogens or underlying disease. We aimed to outline differences and factors contributing to mortality between NHAP 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 frequently used a ventilator, and had disease of higher severity than CAP. The incidences of aspiration, tube feeding, and poor functional status were 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 no association 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 to 55.632) were significantly associated with in-hospital mortality.
CONCLUSION
Patients with NHAP had higher mortality than patients with CAP. The excess mortality among patients with NHAP and CAP was related to disease severity but not to the presence of multidrug resistant pathogens.

Keyword

Pneumonia; nursing home; antimicrobial resistance; mortality

MeSH Terms

Aged
Aged, 80 and over
Anti-Bacterial Agents/*therapeutic use
Community-Acquired Infections/drug therapy/microbiology/mortality
Cross Infection/drug therapy/*mortality
*Drug Resistance, Multiple, Bacterial
Female
*Hospital Mortality
Humans
Male
*Nursing Homes
Odds Ratio
Pneumonia, Bacterial/drug therapy/microbiology/*mortality
Retrospective Studies
Anti-Bacterial Agents

Cited by  2 articles

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Jung Yeon Heo, Joon Young Song
Infect Chemother. 2018;50(4):287-300.    doi: 10.3947/ic.2018.50.4.287.

Guideline for Antibiotic Use in Adults with Community-acquired Pneumonia
Mi Suk Lee, Jee Youn Oh, Cheol-In Kang, Eu Suk Kim, Sunghoon Park, Chin Kook Rhee, Ji Ye Jung, Kyung-Wook Jo, Eun Young Heo, Dong-Ah Park, Gee Young Suh, Sungmin Kiem
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