Clinical characteristics of nursing home-acquired pneumonia in elderly patients admitted to a Korean teaching hospital

• Published in: The Korean journal of internal medicine 2015, 30(5), , pp.638-647
• Main Authors: Koh, Seong Joo, Lee, Jong Hoo
• Format: Article
• Language: English
• Subjects: Age Factors; Aged; Aged, 80 and over; Anti-Bacterial Agents - therapeutic use; Chi-Square Distribution; Community-Acquired Infections - diagnosis; Community-Acquired Infections - microbiology; Community-Acquired Infections - mortality; Community-Acquired Infections - therapy; Cross Infection - diagnosis; Cross Infection - microbiology; Cross Infection - mortality; Cross Infection - therapy; Drug Resistance, Bacterial; Female; Homes for the Aged; Hospital Mortality; Hospitals, Teaching; Humans; Logistic Models; Male; Microbial Sensitivity Tests; Multivariate Analysis; Nursing Homes; Odds Ratio; Original; Patient Admission; Pneumonia, Bacterial - diagnosis; Pneumonia, Bacterial - microbiology; Pneumonia, Bacterial - mortality; Pneumonia, Bacterial - therapy; Republic of Korea; Retrospective Studies; Risk Factors; Severity of Illness Index; Treatment Outcome; 내과학
• ISSN: 1226-3303; 2005-6648
• DOI: 10.3904/kjim.2015.30.5.638

Nursing home-acquired pneumonia (NHAP) is included under healthcare-associated pneumonia. However, the optimal treatment strategy for NHAP has been controversial in several studies. We evaluated the clinical features of NHAP compared to community-acquired pneumonia (CAP) in elderly patients admitted with pneumonia. This was a retrospective study in elderly patients aged ≥ 65 years with NHAP or CAP who were hospitalized at Jeju National University Hospital between January 2012 and April 2013. A total of 209 patients were enrolled, and 58 (27.7%) had NHAP. The patients with NHAP were older, had more frequent central nervous system disorders, and showed worse clinical parameters. Potential drug-resistant pathogens were more frequently detected in the NHAP group (22.4% vs. 9.9%, p = 0.018), and the incidences of Pseudomonas aeruginosa and methicillin-resistant Staphylococcus aureus were 8.6% and 10.3%, respectively. In-hospital mortality occurred in 13 patients (22.4%) with NHAP and 17 patients (11.2%) with CAP (p = 0.039). In multivariate analyses, only higher pneumonia severity index (PSI) score was associated with increased mortality (p < 0.001), and the PSI score was higher in the NHAP group than that in the CAP group. Elderly patients admitted with NHAP showed more severe pneumonia at onset, higher rates of potentially drug-resistant pathogens, and worse clinical outcomes than those with CAP. However, higher in-hospital mortality in those with NHAP seemed to be related to the PSI score reflecting host factors and severity of pneumonia rather than the type of pneumonia or the presence of drug-resistant pathogens.