DEATH FROM A SECOND HIT: EPIDEMIOLOGY OF HOSPITAL-ACQUIRED PNEUMONIA IN PORTUGUESE HOSPITALS

Abstract

SESSION TITLE: Chest Infections Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: Hospital acquired pneumonia (HAP) is a common discharge diagnosis in patients admitted both to surgical and medical wards, and it seems to be associated with increased mortality and morbidity. Recent epidemiological data points to an incidence roughly between 0.5 and 2%. Ventilator associated pneumonia accounts for about 1/3 of these episodes. Still, there is scarce information regarding HAP distribution, risk factors, the impact of age, differences between surgical and medical patients, strategies for prevention (outside the intensive care unit), and health costs, especially hospital length of stay and mortality. METHODS: Exploratory analysis of the Portuguese National Health Service (NHS) hospital discharge diagnosis database. All adult inpatients discharged between 2014 and 2017 with a new diagnosis of pneumonia (“not present on admission”) were included. Demographic data, type of admission (either medical or surgical), the need for invasive ventilation, hospital length of stay and mortality were collected. This study was approved by the Central Administration of the National Health System. RESULTS: During this four-year period there were 3.026.233 adult discharges from the Portuguese NHS. There were 28.633 diagnosis of HAP, a mean of 596.5 cases per month, with an overall incidence of 0.95%, ranging between 0.77% (2017) to 1.23% (2016). HAP was more prevalent in patients older than 65 years (accounting for 76.1% of all HAP episodes) and in the male gender, 61.7%, although the same represented only 55.7% of all hospital admissions Surgical patients represented 27.4% of HAP. These patients were younger (73 vs. 78 years), had longer hospital stay (28 vs. 18 days) but lower mortality rate (30.7 vs. 35.0%). Invasive ventilation was common (18.8%) either as directly associated (ventilator associated pneumonia) or as a rescue therapy. Hospital mortality in ventilated patients was higher, 42% vs. 31.9%. Overall, hospital acquired pneumonia was strongly associated with both a very prolonged length of hospital stay (mean 26.4 days) and mortality (33.6%). Mortality increased sharply with age, being 40% in patients older than 85 years. But even in patients <30years, mortality was stil 12.4%. CONCLUSIONS: HAP is frequent in mainland Portugal, both in surgical and medical wards, more common in old patients but affecting all ages. HAP is strongly associated with the need of invasive ventilation, a very long length of stay and mortality. CLINICAL IMPLICATIONS: HAP is a frequent complication in hospitalised patients and strongly associated with the need of invasive ventilation, a very long length of stay and mortality. DISCLOSURES: No relevant relationships by Luis Filipe Froes, source=Web Response no disclosure on file for João Gonçalves-Pereira; no disclosure on file for Paulo Mergulhão; no disclosure on file for Baltazar Nunes; No relevant relationships by Monica Pereira, source=Web Response No relevant relationships by André Simões, source=Web Response