Outcomes of Patients Hospitalized with Community-Acquired, Health Care-Associated, and Hospital-Acquired Pneumonia

Mario Venditti, Marco Falcone, Salvatore Corrao, Giuseppe Licata, Pietro Serra, Francesco Salerno, Sebastiano Filetti, Emilio D'Erasmo, Filippo Rossi Fanelli, Alessandra Fiorentini, Luigi Cricco, Laura Gasbarrone, Cecilia Serafini, Riccardo Ghio, Gabriele Zoppoli, Michele Cortellaro, Marina Magenta, Ranuccio Nuti, Roberto Valenti, Vincenzo MilanoCamillo Brandimarte, Paolo Carfagna, Riccardo Di Sciacca, Antonino Tuttolomondo, Maria Grazia Serra, Mauro Bernardi, Silvia Li Bassi, Vincenzo Stanghellini, Elena Boschi, Salvatore Antonaci, Francesco Vella, Antonino Catalano, Maria Luisa Zeneroli, Elisabetta Ascari, Alberto Veggetti, Roberto Manfredini, Susanna Gamberoni, Gianfranco Guarnieri, Angela Fioretto, Dario Di Michele, Domenico Parisi, Nicola Lucio Liberato, Esio Ronchi, Simonetta Sturbini, Paolo Canafoglia, Massimo Gallerani, Benedetta Boari, Ingrid Nielsen, Giorgio Annoni, Anna Rossetti, Matteo Bernasconi, Carmela Giannatempo, Roberta Turconi, Maurizio Colombo, Alberto Tedeschi, Raffaella Rossi, Roberto Cappelli, Valentina Guidi, Rodolfo Tassara, D. De Melis, Roberto Cosentini, Margherita Arioli, Giulia Gobbo, Fabio Presotto, Sergio Gallana, Carlo Balduini, Giampiero Bertolino, Giacomo Fera, Gino Roberto Corazza, Ida Capriglione, Giulia Pilerio, Maria Domenica Cappellini, Giovanna Fabio, Maria Carrabba, Chin Wu Sheng, Maria Beatrice Secchi, Michele Leone, Lucrezia De Feudis, Massimo Gunelli, Orazio Ferri, Carlo Doroldi, Roberta Pistis, Maria Grazia Sabbadini, Moreno Tresoldi, Paola Lambelet, Stefano Fascetti, Massimo Vanoli, Gianluca Casella, Enrico Agabiti Rosei, Andrea Salvi, Alfonso Noto, Antonio Perciaccante, Claudio Santini, Maurizia Galiè, Giovanni Gasbarrini, Antonio Grieco, Barbara Nardi, Aldo Gaetano Baritussio, Roberto Vannuccini, Mauro Cappelletti, Nicolò Gentiloni-Silveri, Alessandro Lechi, Germana Montesi

Research output: Contribution to journalArticle

Abstract

Background: Traditionally, pneumonia has been classified as either community- or hospital-acquired. Although only limited data are available, health care-associated pneumonia has been recently proposed as a new category of respiratory infection. "Health care-associated pneumonia" refers to pneumonia in patients who have recently been hospitalized, had hemodialysis, or received intravenous chemotherapy or reside in a nursing home or long-term care facility. Objective: To ascertain the epidemiology and outcome of community-acquired, health care-associated, and hospital-acquired pneumonia in adults hospitalized in internal medicine wards. Design: Multicenter, prospective observational study. Setting: 55 hospitals in Italy comprising 1941 beds. Patients: 362 patients hospitalized with pneumonia during two 1-week surveillance periods. Measurements: Cases of radiologically and clinically assessed pneumonia were classified as community-acquired, health care-associated, or hospital-acquired and rates were compared. Results: Of the 362 patients, 61.6% had community-acquired pneumonia, 24.9% had health care-associated pneumonia, and 13.5% had hospital-acquired pneumonia. Patients with health care-associated pneumonia had higher mean Sequential Organ Failure Assessment scores than did those with community-acquired pneumonia (3.0 vs. 2.0), were more frequently malnourished (11.1% vs. 4.5%, and had more frequent bilateral (34.4% vs. 19.7%) and multilobar (27.8% vs. 21.5%) involvement on a chest radiograph. Patients with health care-associated pneumonia also had higher fatality rates (17.8% [CI, 10.6% to 24.9%] vs. 6.7% [CI, 2.9% to 10.5%]) and longer mean hospital stay (18.7 days [CI, 15.9 to 21.5 days] vs. 14.7 days [CI, 13.4 to 15.9 days]). Logistic regression analysis revealed that depression of consciousness (odds ratio [OR], 3.2 [CI, 1.06 to 9.8]), leukopenia (OR, 6.2 [CI, 1.01 to 37.6]), and receipt of empirical antibiotic therapy not recommended by international guidelines (OR, 6.4 [CI, 2.3 to 17.6]) were independently associated with increased intrahospital mortality. Limitations: The number of patients with health care-associated pneumonia was relatively small. Microbiological investigations were not always homogeneous. The study included only patients with pneumonia that required hospitalization; results may not apply to patients treated as outpatients. Conclusion: Health care-associated pneumonia should be considered a distinct subset of pneumonia associated with more severe disease, longer hospital stay, and higher mortality rates. Physicians should differentiate between patients with health care-associated pneumonia and those with community-acquired pneumonia and provide more appropriate initial antibiotic therapy. Funding: None.

Original languageEnglish
Pages (from-to)19-26
Number of pages8
JournalAnnals of Internal Medicine
Volume150
Issue number1
Publication statusPublished - Jan 6 2009

ASJC Scopus subject areas

  • Internal Medicine

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    Venditti, M., Falcone, M., Corrao, S., Licata, G., Serra, P., Salerno, F., Filetti, S., D'Erasmo, E., Fanelli, F. R., Fiorentini, A., Cricco, L., Gasbarrone, L., Serafini, C., Ghio, R., Zoppoli, G., Cortellaro, M., Magenta, M., Nuti, R., Valenti, R., ... Montesi, G. (2009). Outcomes of Patients Hospitalized with Community-Acquired, Health Care-Associated, and Hospital-Acquired Pneumonia. Annals of Internal Medicine, 150(1), 19-26.