DOI QR코드

DOI QR Code

Clinical characteristics of nursing home-acquired pneumonia in elderly patients admitted to a Korean teaching hospital

  • Koh, Seong Joo (Department of Internal Medicine, Jeju National University School of Medicine) ;
  • Lee, Jong Hoo (Department of Internal Medicine, Jeju National University School of Medicine)
  • 투고 : 2014.04.12
  • 심사 : 2014.09.16
  • 발행 : 2015.09.01

초록

Background/Aims: Nursing home-acquired pneumonia (NHAP) is included under healthcare-associated pneumonia. However, the optimal treatment strategy for NHAP has been controversial in several studies. We evaluated the clinical features of NHAP compared to community-acquired pneumonia (CAP) in elderly patients admitted with pneumonia. Methods: This was a retrospective study in elderly patients aged ${\geq}65years$ with NHAP or CAP who were hospitalized at Jeju National University Hospital between January 2012 and April 2013. Results: A total of 209 patients were enrolled, and 58 (27.7%) had NHAP. The patients with NHAP were older, had more frequent central nervous system disorders, and showed worse clinical parameters. Potential drug-resistant pathogens were more frequently detected in the NHAP group (22.4% vs. 9.9%, p = 0.018), and the incidences of Pseudomonas aeruginosa and methicillin-resistant Staphylococcus aureus were 8.6% and 10.3%, respectively. In-hospital mortality occurred in 13 patients (22.4%) with NHAP and 17 patients (11.2%) with CAP (p = 0.039). In multivariate analyses, only higher pneumonia severity index (PSI) score was associated with increased mortality (p < 0.001), and the PSI score was higher in the NHAP group than that in the CAP group. Conclusions: Elderly patients admitted with NHAP showed more severe pneumonia at onset, higher rates of potentially drug-resistant pathogens, and worse clinical outcomes than those with CAP. However, higher in-hospital mortality in those with NHAP seemed to be related to the PSI score reflecting host factors and severity of pneumonia rather than the type of pneumonia or the presence of drug-resistant pathogens.

키워드

과제정보

연구 과제 주관 기관 : Jeju National University

참고문헌

  1. Statistics Korea. Korean Statistical Information Service [Internet]. Daejeon (KR): Statistics Korea, c2013 [cited 2013 Sep 18]. Available from: http://kostat.go.kr/portal/korea/index.action.
  2. American Thoracic Society; Infectious Diseases Society of America. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med 2005;171:388-416. https://doi.org/10.1164/rccm.200405-644ST
  3. Lim WS, Baudouin SV, George RC, et al. BTS guidelines for the management of community acquired pneumonia in adults: update 2009. Thorax 2009;64 Suppl 3:iii1-iii55.
  4. Ewig S, Klapdor B, Pletz MW, et al. Nursing-home-acquired pneumonia in Germany: an 8-year prospective multicentre study. Thorax 2012;67:132-138. https://doi.org/10.1136/thoraxjnl-2011-200630
  5. Ma HM, Wah JL, Woo J. Should nursing home-acquired pneumonia be treated as nosocomial pneumonia? J Am Med Dir Assoc 2012;13:727-731. https://doi.org/10.1016/j.jamda.2012.07.006
  6. Polverino E, Dambrava P, Cilloniz C, et al. Nursing home-acquired pneumonia: a 10 year single-centre experience. Thorax 2010;65:354-359. https://doi.org/10.1136/thx.2009.124776
  7. Liapikou A, Polverino E, Cilloniz C, et al. A worldwide perspective of nursing home-acquired pneumonia compared with community-acquired pneumonia. Respir Care 2014;59:1078-1085. https://doi.org/10.4187/respcare.02788
  8. Nakagawa N, Saito Y, Sasaki M, Tsuda Y, Mochizuki H, Takahashi H. Comparison of clinical profile in elderly patients with nursing and healthcare-associated pneumonia, and those with community-acquired pneumonia. Geriatr Gerontol Int 2014;14:362-371. https://doi.org/10.1111/ggi.12110
  9. Fine MJ, Medsger AR, Stone RA, et al. The hospital discharge decision for patients with community-acquired pneumonia: results from the Pneumonia Patient Outcomes Research Team cohort study. Arch Intern Med 1997;157:47-56. https://doi.org/10.1001/archinte.1997.00440220051007
  10. Lim WS, van der Eerden MM, Laing R, et al. Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study. Thorax 2003;58:377-382. https://doi.org/10.1136/thorax.58.5.377
  11. Geckler RW, Gremillion DH, McAllister CK, Ellenbogen C. Microscopic and bacteriological comparison of paired sputa and transtracheal aspirates. J Clin Microbiol 1977;6:396-399.
  12. Trouillet JL, Chastre J, Vuagnat A, et al. Ventilator-associated pneumonia caused by potentially drug-resistant bacteria. Am J Respir Crit Care Med 1998;157:531-539. https://doi.org/10.1164/ajrccm.157.2.9705064
  13. El-Solh AA. Nursing home acquired pneumonia: approach to management. Curr Opin Infect Dis 2011;24:148-151. https://doi.org/10.1097/QCO.0b013e328343b6cc
  14. El-Solh AA, Sikka P, Ramadan F, Davies J. Etiology of severe pneumonia in the very elderly. Am J Respir Crit Care Med 2001;163(3 Pt 1):645-651. https://doi.org/10.1164/ajrccm.163.3.2005075
  15. El-Solh AA, Pietrantoni C, Bhat A, et al. Microbiology of severe aspiration pneumonia in institutionalized elderly. Am J Respir Crit Care Med 2003;167:1650-1654. https://doi.org/10.1164/rccm.200212-1543OC
  16. Martinez-Moragon E, Garcia Ferrer L, Serra Sanchis B, Fernandez Fabrellas E, Gomez Belda A, Julve Pardo R. Community-acquired pneumonia among the elderly: differences between patients living at home and in nursing homes. Arch Bronconeumol 2004;40:547-552.
  17. Kollef MH, Shorr A, Tabak YP, Gupta V, Liu LZ, Johannes RS. Epidemiology and outcomes of health-care-associated pneumonia: results from a large US database of culture-positive pneumonia. Chest 2005;128:3854-3862. https://doi.org/10.1378/chest.128.6.3854
  18. Zilberberg MD, Shorr AF, Micek ST, Mody SH, Kollef MH. Antimicrobial therapy escalation and hospital mortality among patients with health-care-associated pneumonia: a single-center experience. Chest 2008;134:963-968. https://doi.org/10.1378/chest.08-0842
  19. Micek ST, Kollef KE, Reichley RM, Roubinian N, Kollef MH. Health care-associated pneumonia and community-acquired pneumonia: a single-center experience. Antimicrob Agents Chemother 2007;51:3568-3573. https://doi.org/10.1128/AAC.00851-07
  20. Chalmers JD, Taylor JK, Singanayagam A, et al. Epidemiology, antibiotic therapy, and clinical outcomes in health care-associated pneumonia: a UK cohort study. Clin Infect Dis 2011;53:107-113. https://doi.org/10.1093/cid/cir274
  21. Yoon WK, Kim M, Kim YY, et al. The clinical and microbial characteristics of healthcare-associated pneumonia. Korean J Med 2010;78:709-716.
  22. Cho YJ, Jung BK, Ahn JS. A comparative study of nursing home-acquired pneumonia with community-acquired pneumonia. Tuberc Respir Dis 2011;70:224-234. https://doi.org/10.4046/trd.2011.70.3.224

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