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Tuberculosis & Respiratory Diseases

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Vol.70 No.3
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A Comparative Study of Nursing Home-Acquired Pneumonia with Community-Acquired Pneumonia

Tuberculosis & Respiratory Diseases / Tuberculosis & Respiratory Diseases,
2011, v.70 no.3, pp.224-234
Young-Jae Cho (Kangnam Hospital)
Bong-Ki Jung (Kangnam Hospital Chuncheon)
Joon-Seok Ahn (Kangnam Hospital Chuncheon)
Young-Jae, C. , Bong-Ki, J. , & Joon-Seok, A. (2011). A Comparative Study of Nursing Home-Acquired Pneumonia with Community-Acquired Pneumonia. Tuberculosis & Respiratory Diseases, 70(3), 224-234.
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Abstract

Background: Little data is available regarding hospitalized patients with nursing home-acquired pneumonia (NHAP). This is unfortunate because there is an increasing number of elderly persons who are living in nursing homes in Korea. The aim of this study was to compare clinical characteristics and treatment responses of NHAP with community-acquired pneumonia (CAP). Methods: Patients with pneumonia who were admitted from eight nursing homes or from their own homes were enrolled between May 2007 and April 2009. Their clinical characteristics and treatment responses were reviewed retrospectively, and differences between the two groups were analyzed. Results: Of 110 Patients with pneumonia, 66 (60%) were from nursing homes and their median age was 84. In the NHAP group, functional performance status was significantly poorer, classical symptoms of pneumonia were less severe, and multi-lobe involvement (on chest radiographs) was more frequent than in the CAP group. Patients with NHAP more frequently showed lymphocytopenia, anemia, hypoalbuminemia, hypoxemia, and elevated blood urea nitrogen on admission. The mean CURB-65 score was 2.2 in the NHAP group, higher than 1.7 in the CAP group (p=0.004), and multi-drug resistant pathogens were also highly identified in NHAP group (39% vs. 10%, p=0.036). The mean duration of antibiotic therapy was greater for the NHAP (12.6 days) than for the CAP group (6.6 days) (p＜0.001). The mortality rate was 23% in NHAP group, which was significantly higher than 5% in the CAP group (p=0.014). Conclusion: NHAP should be more intensively investigated because of the higher frequency of multi-drug resistant pathogens and mortality than the CAP.

keywords
Nursing Homes, Pneumonia, Community-Acquired, Nursing Homes, Pneumonia, Community-Acquired

Reference

1.

1. Carratalà J, Mykietiuk A, Fernández-Sabé N, Suárez C, Dorca J, Verdaguer R, et al. Health care-associated pneumonia requiring hospital admission: epidemiology, antibiotic therapy, and clinical outcomes. Arch Intern Med 2007;167:1393-9.

2.

2. Kollef MH, Shorr A, Tabak YP, Gupta V, Liu LZ, Johannes RS. Epidemiology and outcomes of healthcare- associated pneumonia: results from a large US database of culture-positive pneumonia. Chest 2005;128: 3854-62.

3.

3. Division of Senior Policy in the Office of Aging Society and Population Policy. Current status of the long-term care facilities of the elderly. Seoul: Ministry of Health and Welfare, Republic of Korea; 2008.

4.

4. American Thoracic Society; Infectious Diseases Society of America. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare- associated pneumonia. Am J Respir Crit Care Med 2005;171:388-416.

5.

5. Polverino E, Dambrava P, Cillóniz C, Balasso V, Marcos MA, Esquinas C, et al. Nursing home-acquired pneumonia: a 10 year single-centre experience. Thorax 2010;65:354-9.

6.

6. Janssens JP, Krause KH. Pneumonia in the very old. Lancet Infect Dis 2004;4:112-24.

7.

7. Ewig S, Welte T, Chastre J, Torres A. Rethinking the concepts of community-acquired and health-care-associated pneumonia. Lancet Infect Dis 2010;10:279-87.

8.

8. Micek ST, Kollef KE, Reichley RM, Roubinian N, Kollef MH. Health care-associated pneumonia and community- acquired pneumonia: a single-center experience. Antimicrob Agents Chemother 2007;51:3568-73.

9.

9. Carratalà J, Fernández-Sabé N, Ortega L, Castellsagué X, Rosón B, Dorca J, et al. Outpatient care compared with hospitalization for community-acquired pneumonia: a randomized trial in low-risk patients. Ann Intern Med 2005;142:165-72.

10.

10. Lim WS, Macfarlane JT. A prospective comparison of nursing home acquired pneumonia with community acquired pneumonia. Eur Respir J 2001;18:362-8.

11.

11. Oken MM, Creech RH, Tormey DC, Horton J, Davis TE, McFadden ET, et al. Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol 1982;5:649-55.

12.

12. Lim WS, van der Eerden MM, Laing R, Boersma WG, Karalus N, Town GI, et al. Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study. Thorax 2003;58:377-82.

13.

13. Yoon WK, Kim M, Kim YY, Lee YJ, Hwangbo Y, Choi KJ, et al. The clinical and microbial characteristics of healthcare-associated pneumonia. Korean J Med 2010; 78:709-16.

14.

14. Committee for the Japanese Respiratory Society Guidelines in Management of Respiratory. Appendix I: nursing- home acquired pneumonia. Respirology 2004;9 Suppl 1:S51-5.

15.

15. Johnson JC, Jayadevappa R, Baccash PD, Taylor L. Nonspecific presentation of pneumonia in hospitalized older people: age effect or dementia? J Am Geriatr Soc 2000;48:1316-20.

16.

16. Marik PE, Kaplan D. Aspiration pneumonia and dysphagia in the elderly. Chest 2003;124:328-36.

17.

17. Quagliarello V, Ginter S, Han L, Van Ness P, Allore H, Tinetti M. Modifiable risk factors for nursing home-acquired pneumonia. Clin Infect Dis 2005;40:1-6.

18.

18. Shanley C, O'Loughlin G. Dysphagia among nursing home residents: an assessment and management pro tocol. J Gerontol Nurs 2000;26:35-48.

19.

19. Falcone M, Serra P, Licata G, Venditti M; Italian Society of Internal Medicine (SIMI). Health care associated pneumonia: a new clinical entity. Arch Intern Med 2008;168:109-10.

20.

20. Mylotte JM. Nursing home-associated pneumonia. Clin Geriatr Med 2007;23:553-65, vi-vii.

21.

21. Kaplan V, Angus DC, Griffin MF, Clermont G, Scott Watson R, Linde-Zwirble WT. Hospitalized community- acquired pneumonia in the elderly: age- and sex-related patterns of care and outcome in the United States. Am J Respir Crit Care Med 2002;165:766-72.

22.

22. Niederman MS, Brito V. Pneumonia in the older patient. Clin Chest Med 2007;28:751-71, vi.

23.

23. Loeb M, Carusone SC, Goeree R, Walter SD, Brazil K, Krueger P, et al. Effect of a clinical pathway to reduce hospitalizations in nursing home residents with pneumonia: a randomized controlled trial. JAMA 2006;295: 2503-10.

24.

24. El Solh AA, Pietrantoni C, Bhat A, Bhora M, Berbary E. Indicators of potentially drug-resistant bacteria in severe nursing home-acquired pneumonia. Clin Infect Dis 2004;39:474-80.

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