Healthcare Associated Pneumonia
Conditions
Keywords
healthcare associated pneumonia, drug-resistant bacteria, pneumonia severity index
Brief summary
Background The prediction of multi-drug resistant (MDR) pathogens is a key issue in the management of health-care associated pneumonia (HCAP). Multiple risk factors have been proposed, some of which overlap with items of the pneumonia severity index (PSI). The aim of this study was to investigate the relationship between PSI and presence of MDR pathogens. Methods Patients who were admitted to a tertiary-care hospital from January 2005 to December 2010 were screened by a discharge diagnosis of pneumonia. Patients were enrolled if they fulfilled the definition of HCAP by 2005 ATS/IDSA guideline.
Detailed description
MDR bacteria were defined as Pseudomonas aeruginosa (P. aeruginosa), Enterobacter species, those not sensitive to second and third generation cephalosporins, Acinetobacter species, extended-spectrum β-lactamase (ESBL) Enterobacteriaceae such as Escherichia coli (E. coli) and Klebsiella pneumoniae (K. pneumoniae), Burkholderia cepacia (B. cepacia), Stenotrophomonas maltophilia (S. maltophilia), and methicillin resistant Staphylococcus aureus (MRSA). The criteria for HCAP is defined as follows: patients who had been hospitalized in an acute care hospital for two or more days within the past 90 days; residents of a nursing home or long-term care facility; recipients of recent intravenous antibiotic therapy, chemotherapy or wound care within the past 30 days; or patients who attended a hospital or hemodialysis clinic.
Interventions
None listed
Sponsors
Far Eastern Memorial Hospital
Study design
Observational model
COHORT
Time perspective
RETROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* patients who had been hospitalized in an acute care hospital for two or more days within the past 90 days; * residents of a nursing home or long-term care facility; * recipients of recent intravenous antibiotic therapy, chemotherapy or wound care within the past 30 days; * or patients who attended a hospital or hemodialysis clinic.
Exclusion criteria
\-
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Pathogens of Healthcare Associated Pneumonia, Measured by the Number of Participants | 7 days | sputum culture and sterile specimen such as blood or pleural effusion culture for healthcare associated pneumonia within seven days of admission |
| Number of Participants With MDR Pathogens | seven days after admission | MDR bacteria were defined as Pseudomonas aeruginosa (P. aeruginosa), Enterobacter species, those not sensitive to second and third generation cephalosporins, Acinetobacter species, extended-spectrum β-lactamase (ESBL) Enterobacteriaceae such as Escherichia coli (E. coli) and Klebsiella pneumoniae (K. pneumoniae), Burkholderia cepacia (B. cepacia), Stenotrophomonas maltophilia (S. maltophilia), and methicillin resistant Staphylococcus aureus (MRSA). |
Countries
Taiwan
Participant flow
Recruitment details
Patients who were admitted to our hospital,Jan 2005 to Dec 2010 The patients with the diagnosis was pneumonia were selected. They were enrolled if they fulfilled the criteria for HCAP defined in 2005 ATS/IDSA
Participants by arm
| Arm | Count |
|---|---|
| PSI II PSI less than 70 or equal to 70 | 15 |
| PSI III PSI 70-90 | 51 |
| PSI IV PSI 90-130 | 195 |
| PSI V PSI more than 130 | 269 |
| Total | 530 |
Baseline characteristics
| Characteristic | PSI III | PSI IV | PSI II | PSI V | Total |
|---|---|---|---|---|---|
| Age, Categorical <=18 years | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical >=65 years | 30 Participants | 145 Participants | 3 Participants | 252 Participants | 430 Participants |
| Age, Categorical Between 18 and 65 years | 21 Participants | 50 Participants | 12 Participants | 17 Participants | 100 Participants |
| Age, Continuous | 66.4 years STANDARD_DEVIATION 11.7 | 73.3 years STANDARD_DEVIATION 12.5 | 49.7 years STANDARD_DEVIATION 12.5 | 79.5 years STANDARD_DEVIATION 10.2 | 75.1 years STANDARD_DEVIATION 12.8 |
| Region of Enrollment Taiwan | 51 participants | 195 participants | 15 participants | 269 participants | 530 participants |
| Sex: Female, Male Female | 20 Participants | 56 Participants | 5 Participants | 100 Participants | 181 Participants |
| Sex: Female, Male Male | 31 Participants | 139 Participants | 10 Participants | 169 Participants | 349 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk | EG003 affected / at risk |
|---|---|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — | — / — | — / — |
| other Total, other adverse events | 0 / 0 | 0 / 0 | 0 / 0 | 0 / 0 |
| serious Total, serious adverse events | 0 / 0 | 0 / 0 | 0 / 0 | 0 / 0 |
Outcome results
Primary
Number of Participants With MDR Pathogens
MDR bacteria were defined as Pseudomonas aeruginosa (P. aeruginosa), Enterobacter species, those not sensitive to second and third generation cephalosporins, Acinetobacter species, extended-spectrum β-lactamase (ESBL) Enterobacteriaceae such as Escherichia coli (E. coli) and Klebsiella pneumoniae (K. pneumoniae), Burkholderia cepacia (B. cepacia), Stenotrophomonas maltophilia (S. maltophilia), and methicillin resistant Staphylococcus aureus (MRSA).
Time frame: seven days after admission
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| PSI II | Number of Participants With MDR Pathogens | MDR | 1 participants |
| PSI II | Number of Participants With MDR Pathogens | mortality | 0 participants |
| PSI III | Number of Participants With MDR Pathogens | mortality | 3 participants |
| PSI III | Number of Participants With MDR Pathogens | MDR | 13 participants |
| PSI IV | Number of Participants With MDR Pathogens | MDR | 72 participants |
| PSI IV | Number of Participants With MDR Pathogens | mortality | 24 participants |
| PSI V | Number of Participants With MDR Pathogens | MDR | 120 participants |
| PSI V | Number of Participants With MDR Pathogens | mortality | 64 participants |
Comparison: The incidence of MDR pathogens (6.7%, 25.5%, 36.9% and 44.6% in PSI II, III, IV, and V, respectively, p=0.002) and mortality rate (0, 5.9%, 12.3%, and 23.8%, respectively, p\<0.001) increased with increasing PSIp-value: 0.002ANOVA
Primary
Pathogens of Healthcare Associated Pneumonia, Measured by the Number of Participants
sputum culture and sterile specimen such as blood or pleural effusion culture for healthcare associated pneumonia within seven days of admission
Time frame: 7 days
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| PSI II | Pathogens of Healthcare Associated Pneumonia, Measured by the Number of Participants | 15 Participants |
| PSI III | Pathogens of Healthcare Associated Pneumonia, Measured by the Number of Participants | 51 Participants |
| PSI IV | Pathogens of Healthcare Associated Pneumonia, Measured by the Number of Participants | 195 Participants |
| PSI V | Pathogens of Healthcare Associated Pneumonia, Measured by the Number of Participants | 269 Participants |