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Mergulhão P, Pereira JG, Fernandes AV, Krystopchuk A, Ribeiro JM, Miranda D, Castro H, Eira C, Morais J, Lameirão C, Gomes S, Leal D, Duarte J, Pássaro L, Froes F, Martin-Loeches I. Epidemiology and Burden of Ventilator-Associated Pneumonia among Adult Intensive Care Unit Patients: A Portuguese, Multicenter, Retrospective Study (eVAP-PT Study). Antibiotics (Basel) 2024; 13:290. [PMID: 38666966 PMCID: PMC11047600 DOI: 10.3390/antibiotics13040290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 03/18/2024] [Accepted: 03/21/2024] [Indexed: 04/29/2024] Open
Abstract
Ventilator-associated pneumonia (VAP) is a prevailing nosocomial infection in critically ill patients requiring invasive mechanical ventilation (iMV). The impact of VAP is profound, adversely affecting patient outcomes and placing a significant burden on healthcare resources. This study assessed for the first time the contemporary VAP epidemiology in Portugal and its burden on the healthcare system and clinical outcomes. Additionally, resource consumption (duration of iMV, intensive care unit (ICU), hospital length of stay (LOS)) and empirical antimicrobial therapy were also evaluated. This multicenter, retrospective study included patients admitted to the hospital between July 2016 and December 2017 in a participating ICU, who underwent iMV for at least 48 h. Patients with a VAP diagnosis were segregated for further analysis (n = 197). Control patients, ventilated for >48 h but without a VAP diagnosis, were also included in a 1:1 ratio. Cumulative VAP incidence was computed. All-cause mortality was assessed at 28, 90, and 365 days after ICU admission. Cumulative VAP incidence was 9.2% (95% CI 8.0-10.5). The all-cause mortality rate in VAP patients was 24.9%, 34.0%, and 40.6%, respectively, and these values were similar to those observed in patients without VAP diagnosis. Further, patients with VAP had significantly longer ICU (27.5 vs. 11.0 days, p < 0.001) and hospital LOS (61 vs. 35.9 days, p < 0.001), more time under iMV (20.7 vs. 8.0 days, p < 0.001) and were more often subjected to tracheostomy (36.5 vs. 14.2%; p < 0.001). Patients with VAP who received inappropriate empirical antimicrobials had higher 28-day mortality, 34.3% vs. 19.5% (odds ratio 2.16, 95% CI 1.10-4.23), although the same was not independently associated with 1-year all-cause mortality (p = 0.107). This study described the VAP impact and burden on the Portuguese healthcare system, with approximately 9% of patients undergoing iMV for >48 h developing VAP, leading to increased resource consumption (longer ICU and hospital LOS). An unexpectedly high incidence of inappropriate, empirical antimicrobial therapy was also noted, being positively associated with a higher mortality risk of these patients. Knowledge of the Portuguese epidemiology characterization of VAP and its multidimensional impact is essential for efficient treatment and optimized long-term health outcomes of these patients.
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Affiliation(s)
- Paulo Mergulhão
- Intensive Care Unit, Hospital Lusíadas Porto, 4050-115 Porto, Portugal;
| | - João Gonçalves Pereira
- Intensive Care Unit, Hospital de Vila Franca de Xira, 2600-009 Vila Franca de Xira, Portugal;
| | | | - Andriy Krystopchuk
- Intensive Care Unit, Centro Hospitalar Universitário do Algarve, 8000-386 Faro, Portugal;
| | - João Miguel Ribeiro
- Intensive Care Unit, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, 1649-035 Lisbon, Portugal;
| | - Daniel Miranda
- Intensive Care Unit, Centro Hospitalar Vila Nova de Gaia e Espinho, 4434-502 Vila Nova de Gaia, Portugal;
| | - Heloísa Castro
- Intensive Care Unit, Hospital de Santo António, Centro Hospitalar Universitário do Porto, 4099-001 Porto, Portugal;
| | - Carla Eira
- Intensive Care Unit, Centro Hospitalar Tondela Viseu, 3504-509 Viseu, Portugal;
| | - Juvenal Morais
- Intensive Care Unit, Hospital São Francisco Xavier, Centro Hospitalar Lisboa Ocidental, 1449-005 Lisbon, Portugal;
| | - Cristina Lameirão
- Intensive Care Unit, Centro Hospitalar Trás-os-Montes e Alto Douro, 5000-508 Vila Real, Portugal;
| | - Sara Gomes
- Intensive Care Unit, Hospital Prof. Doutor Fernando Fonseca, 2720-276 Amadora, Portugal;
| | - Dina Leal
- Intensive Care Unit, Hospital de Braga, 4710-243 Braga, Portugal;
| | - Joana Duarte
- Medical Affairs Department, MSD Portugal, 2770-192 Oeiras, Portugal; (J.D.); (L.P.)
| | - Leonor Pássaro
- Medical Affairs Department, MSD Portugal, 2770-192 Oeiras, Portugal; (J.D.); (L.P.)
| | - Filipe Froes
- Intensive Care Unit, Hospital Pulido Valente, Centro Hospitalar Universitário Lisboa Norte, 1769-001 Lisbon, Portugal;
| | - Ignacio Martin-Loeches
- Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), St James’ Hospital, D08NYH1 Dublin, Ireland
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Li L, Huang L, Liu X, Ye Y, Sai F, Huang H. Intensive care unit-acquired pneumonia caused by Klebsiella pneumoniae in China: Risk factors and prediction model of mortality. Medicine (Baltimore) 2023; 102:e33269. [PMID: 36961194 PMCID: PMC10035998 DOI: 10.1097/md.0000000000033269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 02/23/2023] [Indexed: 03/25/2023] Open
Abstract
Intensive care unit (ICU)-acquired pneumonia (ICUAP) is a major concern owing to its associated high mortality rate. Few studies have focused on ICUAP caused by Klebsiella pneumoniae (KP). This study aimed to investigate the risk factors for ICUAP-associated death due to KP and to develop a mortality prediction model. Patients with KP-associated ICUAP at Renji Hospital were enrolled from January 2012 to December 2017. The patients were registered from the ICU units of the Surgery, Gynecology and Obstetrics, Neurosurgery, Emergency and Geriatric Departments, and were followed for 30 days. A multivariate analysis was performed to analyze the differences between 30-day survivors and nonsurvivors, and to determine the independent risk factors. Receiver operator characteristic (ROC) curves were also used to determine the predictive power of the model. Among the 285 patients with KP-associated ICUAP, the median age was 70.55 years, and 61.6% were men. Fifty patients died. The nonsurvivors had a lower Glasgow coma score (GCS), platelet count, and albumin concentrations, but higher lactate concentrations, than the survivors. The nonsurvivors were also more likely to be admitted to the ICU for respiratory failure and surgery, and they received less appropriate empirical antimicrobial therapy than the survivors. A lower GCS (odds ratio [OR] = 0.836, 95% confidence interval [CI]: 0.770-0.907), lower albumin concentrations (OR = 0.836, 95% CI: 0.770-0.907), higher lactate concentrations (OR = 1.167, 95% CI: 1.0013-1.344) and inappropriate empirical treatment (OR = 2.559, 95% CI: 1.080-6.065) were independent risk factors for mortality in patients with KP-associated ICUAP. ROC curve analysis showed that the risk of death was higher in patients with 2 or more independent risk factors. The predictive model was effective, with an area under the ROC curve of 0.823 (95% CI: 0.773-0.865). The number of independent risk factors is positively correlated with the risk of death. Our model shows excellent predictive performance.
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Affiliation(s)
- Lanyu Li
- Department of Emergency Medicine, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Liying Huang
- Department of General Practice, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Xiaolei Liu
- Department of Emergency Medicine, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Yan Ye
- Department of Rheumatology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Fangfang Sai
- Department of General Practice, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Huan Huang
- Department of Emergency Medicine, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
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Barreto JV, Dias CC, Cardoso T. Risk factors for community-onset pneumonia caused by drug-resistant pathogens: A prospective cohort study. Eur J Intern Med 2022; 96:66-73. [PMID: 34670681 DOI: 10.1016/j.ejim.2021.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 09/30/2021] [Accepted: 10/07/2021] [Indexed: 11/16/2022]
Abstract
INTRODUCTION There is no consensual definition of risk factors for drug resistant pathogens (DRP) in community-onset pneumonia (COP). Healthcare-associated pneumonia criteria have been abandoned because they were found to have weak discriminative power. Our aim was to identify risk factors for DRP in COP. METHODS Prospective cohort study, conducted over a two years' period, in a community-based hospital, including all adult patients with COP criteria. Univariate and multivariate logistic regression modeling were performed to understand the association of risk factors (demographic, clinical and epidemiological) with COP by a DRP (PES: Pseudomonas aeruginosa, extended-spectrum ß-lactamase producing Enterobacteriaceae, Methicillin-resistant Staphylococcus aureus; and other non-fermenting gram-negative bacteria, namely Acinetobacter baumannii). RESULTS A total of 660 cases of COP were included, with a mean (±SD) age of 74±15 years and 58.9% of males. Microbiological documentation was possible in 32.6% of the cases. There were 197 cases selected for further analysis, of which 37 were cases of PES. The multivariate logistic regression model retained antibiotic use in the previous 90 days (adjusted OR=4.411, 95%CI [1.745-11.148]) and being bed-ridden (adjusted OR=5.492, 95%CI [2.121-14.222]), adjusted for Charlson's Index, CURB 65 and provenience from a long-term care facility. The area under the ROC curve for this model was 0.832, 95%CI [0.756-0.908], higher than the application of the HCAP criteria (AUROC = 0.676, 95%CI [0.582-0.770]). CONCLUSION In this study, antibiotic use in the previous 90 days and being bed-ridden were independently associated with COP caused by DRP, after adjustment for Charlson's Index, CURB 65 and provenience from a long-term care facility.
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Affiliation(s)
- J Vasco Barreto
- Internal Medicine Service, Medicine Department, Hospital Pedro Hispano, Matosinhos Local Health Unit, Rua Dr. Eduardo Torres, 4464-513 Senhora da Hora, Portugal; ICBAS - School of Medicine and Biomedical Sciences, University of Porto, Rua Jorge de Viterbo Ferreira 228, 4050-313 Porto, Portugal.
| | - Cláudia Camila Dias
- Knowledge Management Unit and Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal; CINTESIS - Center for Health Technology and Services Research, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal.
| | - Teresa Cardoso
- ICBAS - School of Medicine and Biomedical Sciences, University of Porto, Rua Jorge de Viterbo Ferreira 228, 4050-313 Porto, Portugal; Intensive Care Unit (UCIP) and Hospital Infection Control Committee, Hospital de Santo António, Oporto University Hospital Center, University of Porto, Largo Prof. Abel Salazar, 4099-001 Porto, Portugal
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Méndez L, Castro P, Ferreira J, Caneiras C. Epidemiological Characterization and the Impact of Healthcare-Associated Pneumonia in Patients Admitted in a Northern Portuguese Hospital. J Clin Med 2021; 10:jcm10235593. [PMID: 34884292 PMCID: PMC8658659 DOI: 10.3390/jcm10235593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 11/26/2021] [Accepted: 11/27/2021] [Indexed: 12/01/2022] Open
Abstract
Pneumonia is one of the main causes of hospitalization and mortality. It’s the fourth leading cause of death worldwide. Healthcare-associated infections are the most frequent complication of healthcare and affect hundreds of millions of patients around the world, although the actual number of patients affected is unknown due to the difficulty of reliable data. The main goal of this manuscript is to describe the epidemiological characteristics of patients admitted with pneumonia and the impact of healthcare-associated pneumonia (HCAP) in those patients. It is a quantitative descriptive study with retrospective analysis of the clinical processes of 2436 individuals for 1 year (2018) with the diagnosis of pneumonia. The individuals with ≤5 years old represented 10.4% (n = 253) and ≥65 were 72.6% (n = 1769). 369 cases resulted in death, which gives a sample lethality rate of 15.2%. The severity and mortality index were not sensitive to the death event. We found 30.2% (n = 735) individuals with HCAP and 0.41% (n = 59) with ventilator-associated pneumonia (VAP). In only 59 individuals (2.4%) the agent causing pneumonia was isolated. The high fatality rate obtained shows that pneumonia is a major cause of death in vulnerable populations. Moreover, HCAP is one of the main causes of hospital admissions from pneumonia and death and the most pneumonias are treated empirically. Knowledge of the epidemiology characterization of pneumonia, especially associated with healthcare, is essential to increase the skills of health professionals for the prevention and efficient treatment of pneumonia.
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Affiliation(s)
- Lucía Méndez
- Pneumology Department, Centro Hospitalar de Entre Douro e Vouga, 4520-221 Santa Maria da Feira, Portugal;
- EnviHealthMicro Lab, Microbiology Research Laboratory on Environmental Health, Institute of Environmental Health (ISAMB), Faculty of Medicine, Universidade de Lisboa, 1649-028 Lisboa, Portugal;
- Correspondence:
| | - Pedro Castro
- Intensive Care Unit, Centro Hospitalar de Entre Douro e Vouga, 4520-221 Santa Maria da Feira, Portugal;
| | - Jorge Ferreira
- Pneumology Department, Centro Hospitalar de Entre Douro e Vouga, 4520-221 Santa Maria da Feira, Portugal;
| | - Cátia Caneiras
- EnviHealthMicro Lab, Microbiology Research Laboratory on Environmental Health, Institute of Environmental Health (ISAMB), Faculty of Medicine, Universidade de Lisboa, 1649-028 Lisboa, Portugal;
- Institute of Preventive Medicine and Public Health, Faculty of Medicine, Universidade de Lisboa, 1649-028 Lisboa, Portugal
- Microbiology and Immunology Department, Faculty of Pharmacy, Universidade de Lisboa, 1649-003 Lisboa, Portugal
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Community-Acquired Pneumonia in HIV-Positive Patients: an Update on Etiologies, Epidemiology and Management. Curr Infect Dis Rep 2017; 19:2. [DOI: 10.1007/s11908-017-0559-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Almeida A, Almeida AR, Castelo Branco S, Vesza Z, Pereira R. CURB-65 and other markers of illness severity in community-acquired pneumonia among HIV-positive patients. Int J STD AIDS 2015; 27:998-1004. [PMID: 26394997 DOI: 10.1177/0956462415605232] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 08/18/2015] [Indexed: 11/15/2022]
Abstract
As the relative burden of community-acquired bacterial pneumonia among HIV-positive patients increases, adequate prediction of case severity on presentation is crucial. We sought to determine what characteristics measurable on presentation are predictive of worse outcomes. We studied all admissions for community-acquired bacterial pneumonia over one year at a tertiary centre. Patient demographics, comorbidities, HIV-specific markers and CURB-65 scores on Emergency Department presentation were reviewed. Outcomes of interest included mortality, bacteraemia, intensive care unit admission and orotracheal intubation. A total of 396 patients were included: 49 HIV-positive and 347 HIV-negative. Mean CURB-65 score was 1.3 for HIV-positive and 2.2 for HIV-negative patients (p < 0.0001), its predictive value for mortality being maintained in both groups (p = 0.03 and p < 0.001, respectively). Adjusting for CURB-65 scores, HIV infection by itself was only associated with bacteraemia (adjusted odds ratio [AOR] 7.1, 95% CI [2.6-19.5]). Patients with < 200 CD4 cells/µL presented similar CURB-65 adjusted mortality (aOR 1.7, 95% CI [0.2-15.2]), but higher risk of intensive care unit admission (aOR 5.7, 95% CI [1.5-22.0]) and orotracheal intubation (aOR 9.1, 95% CI [2.2-37.1]), compared to HIV-negative patients. These two associations were not observed in the > 200 CD4 cells/µL subgroup (aOR 2.2, 95% CI [0.7-7.6] and aOR 0.8, 95% CI [0.1-6.5], respectively). Antiretroviral therapy and viral load suppression were not associated with different outcomes (p > 0.05). High CURB-65 scores and CD4 counts < 200 cells/µL were both associated with worse outcomes. Severity assessment scales and CD4 counts may both be helpful in predicting severity in HIV-positive patients presenting with community-acquired bacterial pneumonia.
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Affiliation(s)
- André Almeida
- Central Lisbon Hospital Centre, Department of Internal Medicine 4, Hospital de Santa Marta, Lisbon, Portugal NOVA Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Ana Rita Almeida
- Higher Institute of Applied Psychology (ISPA), Psychology and Health Research Unit, Lisbon, Portugal
| | - Sara Castelo Branco
- Central Lisbon Hospital Centre, Department of Internal Medicine 4, Hospital de Santa Marta, Lisbon, Portugal NOVA Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Zsófia Vesza
- Central Lisbon Hospital Centre, Department of Internal Medicine 4, Hospital de Santa Marta, Lisbon, Portugal NOVA Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Rui Pereira
- Central Lisbon Hospital Centre, Intensive Care Unit 7, Hospital Curry Cabral, Lisbon, Portugal
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Oliveira J, Zagalo C, Cavaco-Silva P. Prevention of ventilator-associated pneumonia. REVISTA PORTUGUESA DE PNEUMOLOGIA 2014; 20:152-61. [PMID: 24674617 DOI: 10.1016/j.rppneu.2014.01.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Revised: 01/06/2014] [Accepted: 01/08/2014] [Indexed: 12/29/2022] Open
Abstract
Invasive mechanical ventilation (IMV) represents a risk factor for the development of ventilator-associated pneumonia (VAP), which develops at least 48h after admission in patients ventilated through tracheostomy or endotracheal intubation. VAP is the most frequent intensive-care-unit (ICU)-acquired infection among patients receiving IMV. It contributes to an increase in hospital mortality, duration of MV and ICU and length of hospital stay. Therefore, it worsens the condition of the critical patient and increases the total cost of hospitalization. The introduction of preventive measures has become imperative, to ensure control and to reduce the incidence of VAP. Preventive measures focus on modifiable risk factors, mediated by non-pharmacological and pharmacological evidence based strategies recommended by guidelines. These measures are intended to reduce the risk associated with endotracheal intubation and to prevent microaspiration of pathogens to the lower airways.
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Affiliation(s)
- J Oliveira
- CIIEM, Instituto Superior de Ciências da Saúde Egas Moniz, Monte de Caparica, Portugal; TechnoPhage S.A., Lisbon, Portugal
| | - C Zagalo
- CIIEM, Instituto Superior de Ciências da Saúde Egas Moniz, Monte de Caparica, Portugal; Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal
| | - P Cavaco-Silva
- CIIEM, Instituto Superior de Ciências da Saúde Egas Moniz, Monte de Caparica, Portugal; TechnoPhage S.A., Lisbon, Portugal.
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Gupta D, Agarwal R, Aggarwal AN, Singh N, Mishra N, Khilnani GC, Samaria JK, Gaur SN, Jindal SK. Guidelines for diagnosis and management of community- and hospital-acquired pneumonia in adults: Joint ICS/NCCP(I) recommendations. Lung India 2012; 29:S27-62. [PMID: 23019384 PMCID: PMC3458782 DOI: 10.4103/0970-2113.99248] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Dheeraj Gupta
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ritesh Agarwal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ashutosh Nath Aggarwal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Navneet Singh
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Narayan Mishra
- Department of Pulmonary Medicine, Indian Chest Society, India
| | - G. C. Khilnani
- Department of Pulmonary Medicine, National College of Chest Physicians, India
| | - J. K. Samaria
- Department of Pulmonary Medicine, Indian Chest Society, India
| | - S. N. Gaur
- Department of Pulmonary Medicine, National College of Chest Physicians, India
| | - S. K. Jindal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - for the Pneumonia Guidelines Working Group
- Pneumonia Guidelines Working Group Collaborators (43) A. K. Janmeja, Chandigarh; Abhishek Goyal, Chandigarh; Aditya Jindal, Chandigarh; Ajay Handa, Bangalore; Aloke G. Ghoshal, Kolkata; Ashish Bhalla, Chandigarh; Bharat Gopal, Delhi; D. Behera, Delhi; D. Dadhwal, Chandigarh; D. J. Christopher, Vellore; Deepak Talwar, Noida; Dhruva Chaudhry, Rohtak; Dipesh Maskey, Chandigarh; George D’Souza, Bangalore; Honey Sawhney, Chandigarh; Inderpal Singh, Chandigarh; Jai Kishan, Chandigarh; K. B. Gupta, Rohtak; Mandeep Garg, Chandigarh; Navneet Sharma, Chandigarh; Nirmal K. Jain, Jaipur; Nusrat Shafiq, Chandigarh; P. Sarat, Chandigarh; Pranab Baruwa, Guwahati; R. S. Bedi, Patiala; Rajendra Prasad, Etawa; Randeep Guleria, Delhi; S. K. Chhabra, Delhi; S. K. Sharma, Delhi; Sabir Mohammed, Bikaner; Sahajal Dhooria, Chandigarh; Samir Malhotra, Chandigarh; Sanjay Jain, Chandigarh; Subhash Varma, Chandigarh; Sunil Sharma, Shimla; Surender Kashyap, Karnal; Surya Kant, Lucknow; U. P. S. Sidhu, Ludhiana; V. Nagarjun Mataru, Chandigarh; Vikas Gautam, Chandigarh; Vikram K. Jain, Jaipur; Vishal Chopra, Patiala; Vishwanath Gella, Chandigarh
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Guimarães C, Lares Santos C, Costa F, Barata F. [Pneumonia associated with health care versus community acquired pneumonia: different entities, distinct approaches]. REVISTA PORTUGUESA DE PNEUMOLOGIA 2011; 17:168-71. [PMID: 21703809 DOI: 10.1016/j.rppneu.2011.01.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2010] [Accepted: 01/27/2011] [Indexed: 11/26/2022] Open
Abstract
Healthcare-associated pneumonia (HCAP) is now identified as a unique entity that differs from community-acquired pneumonia (CAP), and in many ways is similar to nosocomial pneumonia (NP). Patients with the diagnosis of CAP and HCAP admitted to our Pneumology Unit during one year were retrospectively analysed. The objective was to compare the characteristics and the approach of these two entities. 197 patients were included, 144 with CAP and 53 with HCAP. Sex, age, comorbilities, Pneumonia Severity Index (PSI) score, radiological involvement, bacteriology, treatment and outcomes were analysed in the 2 groups. Compared to CAP, HCAP was associated with more severe disease, a higher mortality rate and greater length of hospitalization. HCAP differed from CAP mainly in bacteriology and outcomes.
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Affiliation(s)
- C Guimarães
- Serviço de Pneumologia, Centro Hospitalar de Coimbra- EPE, Coimbra, Portugal.
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