Korean J Intern Med.
2016 Mar;31(2):296-304. 10.3904/kjim.2014.256.
Facility characteristics as independent prognostic factors of nursing home-acquired pneumonia
- Affiliations
-
- 1Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Myongji Hospital, Seonam University College of Medicine, Goyang, Korea. kmfindie@hanmail.net
- 2Geriatric Center, Department of Family Medicine, Department of Internal Medicine, International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, Korea.
- 3Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, Korea.
- KMID: 2373805
- DOI: http://doi.org/10.3904/kjim.2014.256
Abstract
- BACKGROUND/AIMS
Recently, the incidence of nursing home-acquired pneumonia (NHAP) has been increasing and is now the leading cause of death among nursing home residents. This study was performed to identify risk factors associated with NHAP mortality, focusing on facility characteristics.
METHODS
Data on all patients > or = 70 years of age admitted with newly diagnosed pneumonia were reviewed. To compare the quality of care in nursing facilities, the following three groups were defined: patients who acquired pneumonia in the community, care homes, and care hospitals. In these patients, 90-day mortality was compared.
RESULTS
Survival analyses were performed in 282 patients with pneumonia. In the analyses, 90-day mortality was higher in patients in care homes (12.2%, 40.3%, and 19.6% in community, care homes, and care hospitals, respectively). Among the 118 NHAP patients, residence in a care home, structural lung diseases, treatment with inappropriate antimicrobial agents for accompanying infections, and a high pneumonia severity index score were risk factors associated with higher 90-day mortality. However, infection by potentially drug-resistant pathogens was not important.
CONCLUSIONS
Unfavorable institutional factors in care homes are important prognostic factors for NHAP.
Keyword
MeSH Terms
-
Aged
Aged, 80 and over
Anti-Bacterial Agents/therapeutic use
Cause of Death
Cross Infection/diagnosis/drug therapy/microbiology/*mortality
Female
*Homes for the Aged
*Hospitals
Humans
Inappropriate Prescribing
Kaplan-Meier Estimate
Male
*Nursing Homes
Pneumonia, Bacterial/diagnosis/drug therapy/microbiology/*mortality
Proportional Hazards Models
Retrospective Studies
Risk Factors
Time Factors
Treatment Outcome
Anti-Bacterial Agents
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