Healthcare-associated bacteraemic pneumonia: aetiology, severity of disease and outcomes
Abstract number: O26
Salvado M., Lozano L., Calbo E., Freixes N., Riera M., Xercavins M., Rodriguez-Carballeira M., Garau J.
Introduction: Recent studies have been focused on healthcare-associated pneumonia (HCAP) trying to distinguish them from truly community-acquired (CAP) or hospital acquired pneumonia (HAP). The aim of our study was to describe the aetiology and outcomes of a cohort of patients with bacteraemic pneumonia (BP), regarding their relation to the healthcare-system.
Material and Methods: From Jan 2004 to June 2007, consecutive patients with BP were identified through the records of the Clinical Microbiology Laboratory in a 450-bed acute care teaching hospital. Data obtained included demographics, co morbidities, aetiology, severity of disease (Pitt score), presence of shock, relation with the healthcare-system and in-hospital mortality.
Results: 175 episodes of BP were identified. HAP was diagnosed in 25 patients (14.2%), CAP in 115 (65.3%) and HCAP in 36 (20.5%); mean age was 62.5 (SD 17.3), 57.8 (SD 20), and 75.6 y (SD 12.48), respectively (p = 0.001). Men represented 56%, 69.6% and 55.6% of the HAP, CAP and HCAP (p = 0.2), respectively. Co morbidity, measured by Charlson score, was 2.57 in HA, 1.55 in CAP and 2.03 in HCAP (p = 0.05). Streptococcus pneumoniae was isolated in 36%, 93% and 71.4% (p = 0.001); Staphylococcus aureus was present in 12%, 1.7% and 2.8 (p = 0.037) and Pseudomonas aeruginosa in 24%, 0.9% and 11% of the HAP, CAP and HCAP (p = 0.001). Pitt score was 2.8, 1.03 and 1.14, respectively (p = 0.01). Shock was present on admission in 20% of HAP, 10.4% CAP and in 11% of HCAP (p = 0.4). The in-hospital mortality rate was 40% in HAP, 10% in CAP and 43% in HCAP (p = 0.001). In the multivariate analysis, severity of disease (OR=1.2; CI95% 1.061.5, p = 0.007), HAP (OR=3.9 CI95% 1.213, p = 0.02) and HCAP (OR=5.6; CI95% 1.916.6, p = 0.001) were independent predictive factors for increased mortality.
Conclusions: The majority of BP are seen in patients with CAP. Severity of disease and relation with the healthcare-system are important predictive factors of increased mortality. Although the aetiology in HCAP is similar to CAP, its mortality parallels that of HAP, showing the great impact of host factors on outcome.
|Session name:||18th European Congress of Clinical Microbiology and Infectious Diseases|
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