Abstract
Objective: To identify the incidence and related factors for hospital-acquired pneumonia (HAP) among older bedridden patients in China.Study design and setting: This multicenter registry data-based study conducted between November 2015 and March 2016 surveyed 7,324 older bedridden patients from 25 hospitals in China (six tertiary, 12 non-tertiary, and seven community hospitals). The occurrence of HAP among all participants was monitored by trained investigators. Demographics, hospitalization information and comorbidity differences were compared between patients with and without HAP. A multilevel regression analysis was used to explore the factors associated with HAP.Results: Among 7,324 older bedridden patients, 566 patients were diagnosed with HAP. The incidence of HAP in this study was 13.9 per 1,000 person-days. There were statistical differences in gender, age, length of bedridden days, BMI, smoking, department, undergoing general anesthesia surgery, ventilator application, Charlson comorbity index (CCI) score, disturbance of consciousness, tranquilizer use, glucocorticosteroid use, and antibiotic use between patients with HAP and patients without HAP (all p < 0.05). Multilevel regression analysis found no significant variance for HAP at the hospital level (0.332, t = 1.875, p > 0.05). There were significant differences for the occurrence of HAP among different departments (0.553, t = 4.320, p < 0.01). The incidence density of HAP was highest in the ICU (30.1‰) among the selected departments, followed by the departments of neurosurgery (18.7‰) and neurology medicine (16.6‰). Individual patient-level factors, including older age, disturbance of consciousness, total CCI score, ICU admission, and glucocorticoid and antibiotic use, were found to be associated with the occurrence of HAP (all p < 0.05).Conclusion: A relatively high incidence density of HAP among older bedridden patients was identified, as well as several factors associated with HAP among the population. This suggests that attention should be paid to the effective management of these related factors of older bedridden patients to reduce the occurrence of HAP.
Highlights
The number of bedridden patients increases with the increasing prevalence and incidence of diseases among older population [1]
The results showed that 59.5% of disorders of consciousness were in Hospital-acquired Pneumonia (HAP) patients in the intensive care units (ICUs) department, 18.3% in HAP patients in the neurology medicine department, FIGURE 2 | Daily and cumulative of occurrence of HAP in patients with HAP
Our study demonstrates that the incidence density of HAP among older bedridden patients is as high as 13.9% person-days; this is consistent with the results from other countries that the incidence of HAP is between 8 and 10% of patients admitted to hospital for the older people units [16, 17]
Summary
The number of bedridden patients increases with the increasing prevalence and incidence of diseases among older population [1]. Staying in bed at hospital could cause many complications, and pneumonia is one of the most common complications. Hospital-acquired Pneumonia (HAP) is a major nosocomial infection worldwide resulting in increased morbidity, mortality, and medical costs. Older bedridden patients, whose basic physiological needs are carried out in bed, often accompanied by worse immune, swallowing and respiratory function, are at high risk of HAP [2]. In China, the incidence of hospital- acquired infections in all hospitalized patients was 3.22–5.22%, of which hospital acquired lower respiratory tract infections were 1.76–11.94%.
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