ETIOLOGICAL FEATURES AND ANTIMICROBIAL RESISTANCE IN HEALTHCARE-ASSOCIATED PNEUMONIA

Abstract

Objectives. Healthcare-associated pneumonia develops in patients undergoing regular medical procedures or has a longterm contact with the hospital environment. Several studies have shown important differences in healthcare-associated pneumonia, comparing to other forms of nosocomial pneumonia. The aim of the study is to evaluate the etiological features and antibiotical resistance in patients with healthcare-associated pneumonia, treated in a tertial hospital. Material and methods. A total of 158 patients were analyzed: 52 patients with healthcare-associated pneumonia, 58 with hospital-acquired pneumonia and ventilator-associated pneumonia, and 48 patients with severe community-acquired pneumonia. Microbiological assessment included microscopic examination and sputum culture. Statistical analysis was performed using the χ2 test (Statistica software, version 7.0). Results. Overall „nosocomial” agents were highly detected in the healthcare-associated pneumonia group – 52,4%, however less frequent than in the hospital-acquired pneumonia/ventilator-associated pneumonia group – 73,8% (p<0,01), but more frequent comparing to patients with severe community-acquired pneumonia – 18% (p<0,001). Klebsiela pneumoniae and Pseudomonas aeruginosa were the leaders of the „nosocomial” group bacteria. „Non-nosocomial” germs were isolated in about ½ of patients with healthcare-associated pneumonia (47,6%), in contrast to those with hospital-acquired pneumonia/ventilator-associated pneumonia (26,1%, p<0,05) and those with severe community-acquired pneumonia (82%, p<0,001). Opposed to severe community-acquired pneumonia, pathological agents in healthcare-associated pneumonia manifested higher resistance to protected penicillins and III generation cephalosporines (p<0,01), meropenem and vancomycin. Conclusions. The study showed significant etiological and antibiotic resistance differences of healthcare-associated pneumonia, compared to hospital-acquired pneumonia/ventilator-associated pneumonia and severe community-acquired pneumonia. Thus, the increased risk of infection with antibiotic-resistant germs, in healthcare-associated pneumonia, should be considered before initiating empirical antibiotic therapy.