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Outcomes of Patients with Healthcare-Associated Pneumonia: Worse Disease or Sicker Patients?

Published online by Cambridge University Press:  10 May 2016

Michael B. Rothberg
Affiliation:
Center for Value-Based Care Research, Medicine Institute, Cleveland Clinic, Cleveland, Ohio
Sarah Haessler
Affiliation:
Division of Infectious Diseases, Baystate Medical Center, Springfield, Massachusetts Tufts University School of Medicine, Boston, Massachusetts
Tara Lagu
Affiliation:
Tufts University School of Medicine, Boston, Massachusetts Center for Quality of Care Research, Baystate Medical Center, Springfield, Massachusetts Division of General Medicine, Baystate Medical Center, Springfield, Massachusetts
Peter K. Lindenauer
Affiliation:
Tufts University School of Medicine, Boston, Massachusetts Center for Quality of Care Research, Baystate Medical Center, Springfield, Massachusetts
Penelope S. Pekow
Affiliation:
Center for Quality of Care Research, Baystate Medical Center, Springfield, Massachusetts School of Public Health and Health Sciences, University of Massachusetts, Amherst, Massachusetts
Aruna Priya
Affiliation:
Center for Quality of Care Research, Baystate Medical Center, Springfield, Massachusetts
Daniel Skiest
Affiliation:
Division of Infectious Diseases, Baystate Medical Center, Springfield, Massachusetts Tufts University School of Medicine, Boston, Massachusetts
Marya D. Zilberberg
Affiliation:
School of Public Health and Health Sciences, University of Massachusetts, Amherst, Massachusetts EviMed Research Group, Goshen, Massachusetts
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Background.

Healthcare-associated pneumonia (HCAP) is an entity distinct from community-acquired pneumonia (CAP). HCAP has a higher case-fatality rate, due either to HCAP organisms or to the health status of HCAP patients. The contribution of HCAP criteria to case-fatality rate is unknown.

Methods.

We conducted a retrospective review of adult patients admitted with a diagnosis of pneumonia from July 2007 through November 2011 to 491 US hospitals. HCAP was defined as having at least 1 of the following: prior hospitalization within 90 days, hemodialysis, admission from a skilled nursing facility, or immune suppression. We compared characteristics of patients with CAP and patients with HCAP and explored the contribution of HCAP criteria to case-fatality rate in a hierarchical generalized linear model.

Results.

Of 436,483 patients hospitalized with pneumonia, 149,963 (34.4%) had HCAP. Compared to CAP patients, HCAP patients were older, had more comorbidities, and were more likely to require intensive care unit (ICU) care. In-hospital case-fatality rate was higher among patients with HCAP, compared to those with CAP (11.1% vs 5.1%, P < .001). After adjustment for demographics, comorbidities, presence of other infections, early ICU admission, chronic and acute medications, early tests and therapies, and length of stay, HCAP remained associated with increased case-fatality rate (odds ratio [OR], 1.35 [95% confidence interval (CI), 1.32-1.39]); odds of death increased for each additional HCAP criterion (OR [95% CI]: 1 criterion, 1.27 [1.23-1.31], 2 criteria, 1.55 [1.49-1.62], and 3 or more criteria, 1.88 [1.72-2.06]).

Conclusions.

After adjustment for differences in patient characteristics, HCAP was associated with greater case-fatality rate than CAP. This difference may be due to HCAP organisms or to HCAP criteria themselves.

Type
Original Article
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2014

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