Healthcare-associated Pneumonia: a Prospective Study in Spain

Overview

Journal Rev Esp Quimioter

Specialty Pharmacology

Date 2020 Jul 23

PMID 32693555

Authors

F Arnaiz de Las Revillas

D Sousa

C Ardunay

C Garcia-Vidal

M Montejo

R Rodriguez-Alvarez

J Pasquau

E Bouza

J A Oteo

C Balseiro

C Mendez

N Lwoff

P Llinares

M C Farinas

Affiliations

Soon will be listed here.

Abstract

Objective: The aim of the study was to describe the epidemiological characteristics and factors related to outcome in Streptococcus pneumoniae and methicillin-resistant Staphylococcus aureus (MRSA) healthcare-associated pneumonia (HCAP).

Methods: A 3-year prospective observational epidemiological case study of HCAP was conducted in seven Spanish hospitals. Microbiological and patient characteristics and outcomes were collected and classified by causative pathogen into 4 categories: "S. pneumoniae", "MRSA", "Others" and "Unknown". Patients were followed up 30 days after discharge.

Results: A total of 258 (84.6%) patients were enrolled (170 were men [65.9%]). Mean age was 72.4 years ± 15 years (95% CI [70.54-74.25]). The etiology of pneumonia was identified in 73 cases (28.3%): S. pneumoniae in 35 patients (13.6%), MRSA in 8 (3.1%), and other microorganisms in 30 patients (11.6%). Significant differences in rates of chronic obstructive pulmonary disease (p < 0.05), previous antibiotic treatment (p<0.05), other chronic respiratory diseases, inhaled corticosteroids (p <0.01), and lymphoma (p < 0.05) were observed among the four groups. Patients with MRSA pneumonia had received more previous antibiotic treatment (87.5%). Thirty-three (12.8%) patients died during hospitalisation; death in 27 (81.2%) was related to pneumonia.

Conclusions: The etiology of HCAP was identified in only one quarter of patients, with S. pneumoniae being the most prevalent microorganism. Patients with chronic respiratory diseases more frequently presented HCAP due to MRSA than to S. pneumoniae. Death at hospital discharge was related in most cases to pneumonia.

References

Venditti M, Falcone M, Corrao S, Licata G, Serra P . Outcomes of patients hospitalized with community-acquired, health care-associated, and hospital-acquired pneumonia. Ann Intern Med. 2009; 150(1):19-26. DOI: 10.7326/0003-4819-150-1-200901060-00005. View

Fine M, Auble T, Yealy D, Hanusa B, Weissfeld L, Singer D . A prediction rule to identify low-risk patients with community-acquired pneumonia. N Engl J Med. 1997; 336(4):243-50. DOI: 10.1056/NEJM199701233360402. View

Stenehjem E, Rimland D . MRSA nasal colonization burden and risk of MRSA infection. Am J Infect Control. 2012; 41(5):405-10. PMC: 3685139. DOI: 10.1016/j.ajic.2012.07.017. View

. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med. 2005; 171(4):388-416. DOI: 10.1164/rccm.200405-644ST. View

Dunn L . Pneumonia: classification, diagnosis and nursing management. Nurs Stand. 2005; 19(42):50-4. DOI: 10.7748/ns2005.06.19.42.50.c3901. View

Charlson M, Pompei P, Ales K, MacKenzie C . A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987; 40(5):373-83. DOI: 10.1016/0021-9681(87)90171-8. View

Kollef M, Shorr A, Tabak Y, Gupta V, Liu L, Johannes R . Epidemiology and outcomes of health-care-associated pneumonia: results from a large US database of culture-positive pneumonia. Chest. 2005; 128(6):3854-62. DOI: 10.1378/chest.128.6.3854. View

Huang S, Platt R . Risk of methicillin-resistant Staphylococcus aureus infection after previous infection or colonization. Clin Infect Dis. 2003; 36(3):281-5. DOI: 10.1086/345955. View

Shindo Y, Ito R, Kobayashi D, Ando M, Ichikawa M, Shiraki A . Risk factors for drug-resistant pathogens in community-acquired and healthcare-associated pneumonia. Am J Respir Crit Care Med. 2013; 188(8):985-95. DOI: 10.1164/rccm.201301-0079OC. View

10.

Torres A, Dorca J, Zalacain R, Bello S, Molinos L, Arevalo M . Community-acquired pneumonia in chronic obstructive pulmonary disease: a Spanish multicenter study. Am J Respir Crit Care Med. 1996; 154(5):1456-61. DOI: 10.1164/ajrccm.154.5.8912764. View

11.

Torres A, Blasi F, Dartois N, Akova M . Which individuals are at increased risk of pneumococcal disease and why? Impact of COPD, asthma, smoking, diabetes, and/or chronic heart disease on community-acquired pneumonia and invasive pneumococcal disease. Thorax. 2015; 70(10):984-9. PMC: 4602259. DOI: 10.1136/thoraxjnl-2015-206780. View

12.

Kollef M, Napolitano L, Solomkin J, Wunderink R, Bae I, Fowler V . Health care-associated infection (HAI): a critical appraisal of the emerging threat-proceedings of the HAI Summit. Clin Infect Dis. 2008; 47 Suppl 2:S55-99. DOI: 10.1086/590937. View

13.

Polverino E, Torres A, Menendez R, Cilloniz C, Valles J, Capelastegui A . Microbial aetiology of healthcare associated pneumonia in Spain: a prospective, multicentre, case-control study. Thorax. 2013; 68(11):1007-14. DOI: 10.1136/thoraxjnl-2013-203828. View

14.

Livorsi D, Eckerle M . Developing local treatment guidelines for healthcare-associated pneumonia. Clin Infect Dis. 2014; 59(4):609-10. DOI: 10.1093/cid/ciu332. View

15.

Micek S, Kollef K, Reichley R, Roubinian N, Kollef M . Health care-associated pneumonia and community-acquired pneumonia: a single-center experience. Antimicrob Agents Chemother. 2007; 51(10):3568-73. PMC: 2043297. DOI: 10.1128/AAC.00851-07. View

16.

Falcone M, Russo A, Giannella M, Cangemi R, Scarpellini M, Bertazzoni G . Individualizing risk of multidrug-resistant pathogens in community-onset pneumonia. PLoS One. 2015; 10(4):e0119528. PMC: 4393134. DOI: 10.1371/journal.pone.0119528. View

17.

Carvalho M, Tondella M, McCaustland K, Weidlich L, McGee L, Mayer L . Evaluation and improvement of real-time PCR assays targeting lytA, ply, and psaA genes for detection of pneumococcal DNA. J Clin Microbiol. 2007; 45(8):2460-6. PMC: 1951257. DOI: 10.1128/JCM.02498-06. View

18.

Gollomp K, Rankin S, White C, Mattei P, Harris M, Kilpatrick L . Broad-range bacterial polymerase chain reaction in the microbiologic diagnosis of complicated pneumonia. J Hosp Med. 2011; 7(1):8-13. DOI: 10.1002/jhm.911. View

19.

Bogaert D, de Groot R, Hermans P . Streptococcus pneumoniae colonisation: the key to pneumococcal disease. Lancet Infect Dis. 2004; 4(3):144-54. DOI: 10.1016/S1473-3099(04)00938-7. View

20.

Mandell L, Wunderink R, Anzueto A, Bartlett J, Campbell G, Dean N . Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis. 2007; 44 Suppl 2:S27-72. PMC: 7107997. DOI: 10.1086/511159. View