• J Am Med Dir Assoc · Oct 2012

    Comparative Study

    Should nursing home-acquired pneumonia be treated as nosocomial pneumonia?

    • Hon Ming Ma, Jenny Lee Shun Wah, and Jean Woo.
    • Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, HKSAR, China. hmma@cuhk.edu.hk
    • J Am Med Dir Assoc. 2012 Oct 1;13(8):727-31.

    ObjectivesIt is contentious whether nursing home-acquired pneumonia (NHAP) should be treated as community-acquired pneumonia (CAP) or health care-associated pneumonia. This study aimed to compare NHAP with CAP, and to examine whether multidrug-resistant (MDR) bacteria were significantly more common in NHAP than CAP.DesignA prospective, observational cohort studySettingThe medical unit of a tertiary teaching hospitalParticipantsPatients 65 years and older, hospitalized for CAP and NHAP confirmed by radiographs from October 2009 to September 2010MeasurementsDemographic characteristics, Katz score, Charlson comorbidity index (CCI), pneumonia severity (CURB score), microbiology, and clinical outcomes were measured.ResultsA total of 488 patients were recruited and 116 (23.8%) patients were nursing home residents. Compared with patients with CAP, patients with NHAP were older and had more comorbidities and higher functional dependence level. A larger proportion of patients with NHAP had severe pneumonia (CURB ≥2) than patients with CAP (30.2% vs 20.7%, P = .034). Similar percentages of patients had identified infective causes in the CAP and NHAP groups (27.7% vs 29.3%, P = .734). Viral infection accounted for more than half (55.9%) of NHAP, whereas bacterial infection was the most frequent (69.9%) cause of CAP. MDR bacteria were found in 6 patients of all study subjects. Nursing home residence and history of MDR bacterial infection were risk factors for MDR bacterial pneumonia, which had more severe pneumonia (CURB ≥2). Logistic regression analysis was limited by the small number of patients with MDR bacterial pneumonia.ConclusionIn both CAP and NHAP, MDR bacterial infections were uncommon. Most cases of NHAP were caused by unknown etiology or viral pathogens. We suggest that NHAP should not be treated as nosocomial infection. The empirical treatment of broad-spectrum antibiotics in NHAP should be reserved for patients with severe pneumonia or at high risk of MDR bacterial infection.Copyright © 2012 American Medical Directors Association, Inc. Published by Elsevier Inc. All rights reserved.

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