The comparison of patients with hospitalized health-care-associated pneumonia to community-acquired pneumonia

Abstract

Health-care-associated pneumonia (HCAP) is defined as pneumonia that develops in patients with a history of recent hospitalization, hemodialysis as an outpatient, residence in a nursing home, outpatient intravenous therapy and home wound care. We aimed to compare the initial demographic characteristics, causative agents and prognosis between hospitalized HCAP and community-acquired pneumonia (CAP) patients. HCAP and CAP patients hospitalized between 01 September 2008-01 September 2009 were evaluated retrospectively. Out of 187 patients (131 males, mean age 66.3 ± 14.3 years) who were hospitalized during one-year period, 98 were diagnosed as HCAP and 89 as CAP. Among HCAP patients, 64 (65.3%) had a history of hospitalization in the last 90 days, 26 (26.5%) received outpatient intravenous therapy, 17 (17.3%) had home wound care, 6 (6.1%) were on hemodialysis program in the last 30 days and 4 (4.1%) lived in a nursing home. The causative pathogen was detected in 39 (39.8%) HCAP and 8 (9.0%) CAP patients. The most frequently isolated microorganisms were Pseudomonas aeruginosa and Acinetobacter baumannii in HCAP, and Streptococcus pneumoniae and Haemophilus influenzae in CAP patients. Inappropriate empiric antibiotic treatment was documented in 8 (25.8%) of 39 HCAP patients, in whom a causative agent was isolated whereas the antibiotic treatment was appropriate in all CAP patients. The duration of hospitalization (14.4 ± 11.4 vs. 10.7 ± 7.9 days, p= 0.011) and mortality rate (34.7% vs. 9.0%, p< 0.001) were higher in HCAP compared with CAP patients. As HCAP is different than CAP in terms of patients' characteristics, causative microorganisms and prognosis, it should be considered in all patients hospitalized as CAP. Potentially drug-resistant microorganisms should be taken into consideration in the empirical antibiotic treatment of these patients.