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Tuesday, 10th July 2007
Health Care–Associated Pneumonia Requiring Hospital Admission
Health Care–Associated Pneumonia Requiring Hospital Admission
Source: Archives of Internal Medicine
This prospective study shows that a substantial number of patients currently hospitalized with pneumonia have had recent contact with the health care system through nursing homes, home health care programs, hemodialysis clinics, or hospitalization. Compared with patients with CAP, patients with HCAP were older, had more comorbid conditions, and were more commonly classified into high-risk pneumonia severity index classes. We also documented significant differences in the spectrum of causative organisms and antibiotic susceptibilities between the 2 pneumonia groups. Indeed, patients with HCAP more frequently received an initial inappropriate empirical antibiotic therapy and had higher case-fatality rates.
In recent years, dramatic changes in the health care system have shifted a considerable part of patient care from the hospitals to the community. As a result, the traditional distinction between community- and hospital-acquired infections has become less clear, with some infections having mixed characteristics of both types of acquisition. In this regard, the term health care– associated pneumonia has recently been suggested to describe this patient population. However, as shown in 2 recent reviews dealing with HCAP,15-16 there is limited information to validate this new clinical entity. In fact, most available data come from studies involving hospitalized patients with ventilator-associated pneumonia and nonintubated patients with hospital-acquired pneumonia (HAP). Conversely, little is known about the bacteriology and clinical outcomes of HCAP arising in the community. In a retrospective study conducted in the United States and taken from a large multi-institutional database, Kollef et al20 examined rates of CAP, HCAP, ventilator-associated pneumonia, and HAP. Approximately 50% of patients had CAP and more than 20% had HCAP, with S aureus being a major causative pathogen.
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