Incidence of Antibiotic Treatment Failure in Patients with Nursing Home-Acquired Pneumonia and Community Acquired Pneumonia.

Mariana Lopes,Ana Figueiredo,Daniela Marado,Dilva Silva,Gonçalo Alves Silva,João Gonçalves,Armando Carvalho,Rui Filipe Nogueira,Jorge Fortuna,Carlos Athayde

doi:10.3390/idr13010006

Abstract

Purpose: Nursing home-acquired pneumonia (NHAP) patients are at higher risk of multi-drug resistant infection (MDR) than those with community-acquired pneumonia (CAP). Recent evidence suggests a single risk factor for MDR does not accurately predict the need for broad-spectrum antibiotics. The goal of this study was to compare the rate antibiotic failure between NHAP and CAP patients. Methods: Demographic characteristics, co-morbidities, clinical and laboratory variables, antibiotic therapy, and mortality data were collected retrospectively for all patients with pneumonia admitted to an Internal Medicine Service between April 2017 and April 2018. Results: In total, 313 of 556 patients had CAP and 243 had NHAP. NHAP patients were older, and were more likely to be dependent, to have recent antibiotic use, and to experience treatment failure (odds ratio (OR) 1.583; 95% CI 1.102–2.276; p = 0.013). In multivariate analysis, patient’s origin did not predict treatment failure (OR 1.083; 95% CI 0.726–1.616; p = 0.696). Discussion: Higher rates of antibiotic failure and mortality in NHAP patients were explained by the presence of other risk factors such as comorbidities, more severe presentation, and age. Admission from a nursing home is not a sufficient condition to start broader-spectrum antibiotics.

Highlights

When controlled for age, functional status, and previous antibiotic use, Nursing home-acquired pneumonia (NHAP) no longer predicted antibiotic failure
A higher prevalence of cerebrovascular disease (CVD) in NHAP patients has been recorded by Kang et al [18], who identified a correlation with risk of aspiration, justifying the worse clinical presentation
Albumin levels at admission were lower in these patients, and blood urea levels were higher, differences that have been associated in the literature with poor functional status as these patients are more likely to have baseline poor nutrition and dehydration according to Nakagawa et al and Martínez-Moragón et al [19,20]

Summary

Introduction

Nursing home-acquired pneumonia (NHAP) patients are at higher risk of multidrug resistant infection (MDR) than those with community-acquired pneumonia (CAP). The goal of this study was to compare the rate antibiotic failure between NHAP and CAP patients. Discussion: Higher rates of antibiotic failure and mortality in NHAP patients were explained by the presence of other risk factors such as comorbidities, more severe presentation, and age. The incidence of pneumonia in residents of long-term care facilities is estimated to be 10 times higher than in the general population, whereas the rate of hospital admissions is 30 times higher [2], with pneumonia being the most frequent infectious cause of hospital admission in nursing home patients [3]. Mortality is higher in patients with nursing home-acquired pneumonia (NHAP) at about 20%, which is a similar rate to hospital-acquired pneumonia (HAP) [4]. The HCAP classification was based on two large U.S studies [5] that showed an elevated risk of infection with ms in published maps and institutional affiliations

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