Healthcare-associated pneumonia management could be improved

By Liam Davenport

Although healthcare-associated pneumonia (HCAP) is common among patients treated in internal medicine departments (IMD) and linked to poor outcomes, rates of testing and adherence to therapeutic guidelines are low, say Spanish investigators.

HCAP, which is an intermediate category between community-acquired pneumonia (CAP) and hospital-acquired pneumonia (HAP), identifies patients who acquire pneumonia outside of hospital but were institutionalized or had frequent healthcare exposure due to their underlying chronic condition.

Noting that there is debate over the importance of HCAP, Maddalena Giannella, from Hospital General Universitario Gregorio Marañón in Madrid, and colleagues asked physicians from 72 IMDs to report on all patients with pneumonia hospitalized during two 1-week periods in 2010.

Of 1002 pneumonia episodes included in the analysis, 58.9% were CAP, 30.6% were HCAP, and 10.4% were HAP. Compared with CAP and HAP patients, those with HCAP were significantly older, at 83 years versus 77 and 81 years, respectively.

They also had significantly poorer functional status than CAP and HAP patients, with Barthel scores of 30 versus 100 and 65, respectively, and were significantly more likely to have risk factors for aspiration pneumonia, at 50% versus 18% and 34%, respectively.

In-hospital mortality was 8%, 19%, and 27% for CAP, HCAP, and HAP patients, respectively. In addition, Streptococcus pneumonaie caused a respective 63.5%, 38.5%, and 14.3% of cases, the team notes in the journal Clinical Microbiology and Infection.

Among HCAP patients, 17.0% of cases were caused by Pseudomonas aeruginosa and 12.3% were caused by methicillin-resistant Staphylococcus aureus (MRSA).

The researchers also report that independent risk factors for pneumonia due to difficult-to-treat microorganisms - Enterobacteriaceae, P. aeruginosa, or MRSA - were HCAP, chronic obstructive pulmonary disease, and an increased Port Severity Index, at odds ratios of 3.48, 2.42, and 1.01, respectively.

Nevertheless, HCAP patients were significantly less likely to undergo testing to determine an etiological diagnosis than CAP and HAP patients, at 72%, 87%, and 79%, respectively.

The team writes: "In conclusion, our data confirm the importance of maintaining high awareness of HCAP, given the different aetiologies, therapeutic needs and prognosis of this condition among patients treated in IMDs."

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