Korean J Intern Med.  2015 Sep;30(5):638-647. 10.3904/kjim.2015.30.5.638.

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

• Koh SJ
• Lee JH

• KMID: 2381562
• DOI: http://doi.org/10.3904/kjim.2015.30.5.638

Abstract

BACKGROUND/AIMS
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.
METHODS
This was a retrospective study in elderly patients aged > or = 65 years with NHAP or CAP who were hospitalized at Jeju National University Hospital between January 2012 and April 2013.
RESULTS
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.
CONCLUSIONS
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.

Keyword

Nursing care; Pneumonia; Antibiotics; Mortality

MeSH Terms

Age Factors
Aged
Aged, 80 and over
Anti-Bacterial Agents/*therapeutic use
Chi-Square Distribution
Community-Acquired Infections/diagnosis/microbiology/mortality/*therapy
Cross Infection/diagnosis/microbiology/mortality/*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
*Patient Admission
Pneumonia, Bacterial/diagnosis/microbiology/mortality/*therapy
Republic of Korea
Retrospective Studies
Risk Factors
Severity of Illness Index
Treatment Outcome
Anti-Bacterial Agents