Outcomes of patients with healthcare-associated pneumonia: worse disease or sicker patients?

Authors

Sarah Haessler MD, Baystate HealthFollow
Tara Lagu MD, Baystate HealthFollow
Peter Lindenauer MD, Baystate HealthFollow
Aruna Priya, Baystate HealthFollow
Daniel Skiest MD, Baystate HealthFollow

Author Department

Medicine

Document Type

Article, Peer-reviewed

Publication Date

10-2014

Abstract

BACKGROUND:

Healthcare-associated pneumonia (HCAP) is an entity distinct from community-acquired pneumonia (CAP). HCAP has a higher case-fatality rate, due either to HCAP organisms or to the health status of HCAP patients. The contribution of HCAP criteria to case-fatality rate is unknown.

METHODS:

We conducted a retrospective review of adult patients admitted with a diagnosis of pneumonia from July 2007 through November 2011 to 491 US hospitals. HCAP was defined as having at least 1 of the following: prior hospitalization within 90 days, hemodialysis, admission from a skilled nursing facility, or immune suppression. We compared characteristics of patients with CAP and patients with HCAP and explored the contribution of HCAP criteria to case-fatality rate in a hierarchical generalized linear model.

RESULTS:

Of 436,483 patients hospitalized with pneumonia, 149,963 (34.4%) had HCAP. Compared to CAP patients, HCAP patients were older, had more comorbidities, and were more likely to require intensive care unit (ICU) care. In-hospital case-fatality rate was higher amongpatients with HCAP, compared to those with CAP (11.1% vs 5.1%, P < .001). After adjustment for demographics, comorbidities, presence of other infections, early ICU admission, chronic and acute medications, early tests and therapies, and length of stay, HCAP remained associated with increased case-fatality rate (odds ratio [OR], 1.35 [95% confidence interval (CI), 1.32-1.39]); odds of death increased for each additional HCAP criterion (OR [95% CI]: 1 criterion, 1.27 [1.23-1.31], 2 criteria, 1.55 [1.49-1.62], and 3 or more criteria, 1.88 [1.72-2.06]).

CONCLUSIONS:

After adjustment for differences in patient characteristics, HCAP was associated with greater case-fatality rate than CAP. This difference may be due to HCAP organisms or to HCAP criteria themselves.

Recommended Citation

Rothberg MB, Haessler S, Lagu T, Lindenauer PK, Pekow PS, Priya A, Skiest D, Zilberberg MD. Outcomes of patients with healthcare-associated pneumonia: worse disease or sicker patients? Infect Control Hosp Epidemiol. 2014 Oct;35 Suppl 3:S107-15.