Abstract
BackgroundAlthough prior hospitalization (PH) has been considered as a risk factor for infection with potentially drug-resistant (PDR) pathogens in patients admitted with pneumonia, the evidence is limited. We aimed to elucidate the clinical impact of PH on these patients.MethodsPH was defined as hospitalization for two or more days in the preceding 90 days. Patients with PH-associated pneumonia (PHAP) or community-acquired pneumonia (CAP) were matched using the propensity score matching method, and the clinical outcomes were compared. We also conducted subgroup analyses based on intravenous antibiotic use during PH, duration of PH, and time to re-admission.ResultsA total of 704 patients were identified; the PHAP group included 97 patients (13.7%). After matching according to propensity scores, the baseline characteristics of the PHAP group were similar to those of the CAP group. The isolation rate of PDR pathogens as well as the 30-day and total in-hospital mortality did not differ between propensity score-matched PHAP and CAP patients (13.6% vs. 10.2%, P = 0.485; 10.2% vs. 14.8%, P = 0.362; and 13.6% vs. 15.9%, P = 0.671, respectively). In subgroup analyses, only intravenous antibiotic use during PH was associated with the isolation rate of PDR pathogens (adjusted OR: 5.066; 95% CI: 1.231–20.845).ConclusionsPH itself might not be related with higher isolation rates of PDR pathogens or mortality in patients admitted with pneumonia. Therefore, it seems reasonable that broad spectrum antibiotic therapy for PDR pathogens should be selectively applied to PHAP patients with intravenous antibiotic use during PH.
Highlights
Prior hospitalization (PH) has been considered as a risk factor for infection with potentially drug-resistant (PDR) pathogens in patients admitted with pneumonia, the evidence is limited
Patients admitted with pneumonia who have had prior hospitalization (PH) for two or more days within the past 90 days have been represented as a subgroup of health care-associated pneumonia (HCAP), which is included in the spectrum of hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) [2]
There is little available information focusing on the clinical impact of PH in patients admitted with pneumonia
Summary
Prior hospitalization (PH) has been considered as a risk factor for infection with potentially drug-resistant (PDR) pathogens in patients admitted with pneumonia, the evidence is limited. We aimed to elucidate the clinical impact of PH on these patients. It has been known that recent hospitalization prior to the occurrence of pneumonia was associated with potentially drug-resistant (PDR) pathogens and negatively influenced outcomes [2]. Patients admitted with pneumonia who have had prior hospitalization (PH) for two or more days within the past 90 days have been represented as a subgroup of health care-associated pneumonia (HCAP), which is included in the spectrum of hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) [2]. There has been continuous controversy about the concept of HCAP because of excessive heterogeneity of HCAP definition and the inappropriateness in predicting the risk of PDR pathogens with subsequent
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