Clinical characteristics of patients with hemodialysis-associated pneumonia compared to patients with non-hemodialysis community-onset pneumonia

Abstract

The 2005 ATS/IDSA guidelines included hemodialysis-associated pneumonia (HDAP) as a category of healthcare-associated pneumonia (HCAP). However, the clinical epidemiology of HDAP has been not well established. This study aimed to evaluate the clinical and microbiological characteristics of HDAP patients compared to community-acquired pneumonia (CAP) or other HCAP except HDAP (O-HCAP). We conducted a retrospective observational study on HDAP patients who were admitted between January 2012 and December 2014. We compared clinical features, distribution of microorganisms, antibiotic regimens, and clinical outcomes among the three groups. A total of 914 patients, comprised of 595 patients with CAP, 24 with HDAP, and 295 with O-HCAP, were evaluated. The median PSI score of the HDAP group was higher than that of the CAP group and similar to that of the O-HCAP group. The major pathogens of the HDAP group were Staphylococcus aureus and Klebsiella pneumoniae. The isolation rate of multidrug-resistant (MDR) pathogens and total in-hospital mortality of the HDAP group was similar to those of the CAP group (8.3% vs. 6.8%, p=1.000 and 4.1% vs. 7.5%, p=0.821, respectively). Otherwise, the isolation rate of MDR pathogens and total in-hospital mortality rate in the O-HCAP group were at 15.2% and 16.9%, respectively, and were the highest among the three groups. Based on microorganisms and clinical outcomes, the HDAP group was clinically more similar to the CAP group than the O-HCAP group. Therefore, the 2005 ATS/IDSA guidelines that include HDAP as a category of HCAP might be reassessed.