Clinical and microbiological features of patients admitted to the intensive care unit with nursing and healthcare-associated pneumonia

• Published in: Journal of international medical research 2015-04, Vol.43 (2), p.236-249
• Main Authors: Lee, Myoung Kyu, Kim, Sang-Ha, Yong, Suk Joong, Shin, Kye Chul, Park, Hyeon Cheol, Choi, Jiwon, Choi, Yeun Seoung, Seong, Jae Ho, Jung, Ye-Ryung, Lee, Won-Yeon
• Format: Article
• Language: English
• Subjects: Acinetobacter Infections - drug therapy; Acinetobacter Infections - microbiology; Acinetobacter Infections - mortality; Aged; Aged, 80 and over; Anti-Bacterial Agents - therapeutic use; Critical Care; Cross Infection - drug therapy; Cross Infection - microbiology; Cross Infection - mortality; Drug Therapy, Combination; Female; Humans; Klebsiella Infections - drug therapy; Klebsiella Infections - microbiology; Klebsiella Infections - mortality; Male; Middle Aged; Multivariate Analysis; Nursing Care; Pneumonia, Bacterial - drug therapy; Pneumonia, Bacterial - microbiology; Pneumonia, Bacterial - mortality; Respiratory Care Units; Retrospective Studies; Treatment Outcome
• ISSN: 0300-0605; 1473-2300
• DOI: 10.1177/0300060514551188

Objective To evaluate clinical and microbiological features in patients with nursing and healthcare-associated pneumonia (NHCAP), admitted to the intensive care unit (ICU). Methods Demographic, clinical and microbiological data were retrospectively reviewed from patients with NHCAP admitted to a respiratory ICU. Patients were categorized into one of four NHCAP groups: (A) residence in a long-term nursing-home setting or healthcare home; (B) hospital discharge in the preceding 90 days; (C) elderly or physically disabled patients who stay at home but require healthcare; (D) continuously receiving outpatient endovascular therapy including chronic dialysis, anticancer drugs, and immunosuppressants. Pneumonia severity index (PSI), CURB-65, duration of ICU stay and 30-day mortality were evaluated. Results Out of 428 patients reviewed (male, 67.1%; mean age, 71.2 ± 11.9 years), 30-day mortality was 25.5%, and duration of ICU stay was 13.8 ± 13.3 days. Mortality rate was not significantly different between the four NHCAP groups; duration of ICU stay was significantly longer in groups C and D. PSI score, serum HCO3– level, duration of ICU stay, extended spectrum β-lactamase (ESBL)-producing Klebsiella pneumoniae and multidrug resistant (MDR) Acinetobacter baumannii were significantly associated with 30-day mortality. Conclusion ESBL-producing K. pneumoniae, MDR A. baumannii and PSI score should be considered in ICU patients with NHCAP.