Multicenter study of hospital-acquired pneumonia in non-ICU patients.
OBJECTIVE
To know the incidence, epidemiology, etiology, and outcome of hospital-acquired pneumonia (HAP) in non-ICUs adult patients.


METHODS
Twelve Spanish teaching hospitals.


METHODS
From April 1999 to November 2000, non-ICU HAP was prospectively studied by active, bimonthly 1-week surveillance. Epidemiologic data, etiology, and evolution of pneumonia were recorded. Blood and sputum cultures and Legionella pneumophila and Streptococcus pneumoniae urinary antigen tests were performed.


RESULTS
We included 186 patients, with complete data available in 165 patients (70.3% male gender; mean age, 63.7 +/- 16.9 years [ +/- SD]) The mean incidence of HAP was 3 +/- 1.4 cases/1,000 hospital admissions. Most patients (64.2%) were in medical wards, had severe underlying diseases (66.6%), and had a hospital stay > 5 days (76.4%). Blood cultures were performed in 139 patients (84.2%), sputum cultures were performed in 89 patients (53.9%), and urinary antigen detection was performed in 123 patients (74.5%). An etiologic diagnosis was obtained in 60 cases (36.4%), and 31 were definitive. The most frequent etiologies were S pneumoniae (16 cases, 14 definitive), L pneumophila (7 cases, 7 definitive), Aspergillus sp (7 cases, 3 definitive), Pseudomonas aeruginosa (7 cases, 2 definitive), and several Enterobacteriaceae (8 cases, 4 definitive). Clinical complications occurred in 52.1% of the cases, and mortality was 26% (13.9% attributed to pneumonia).


CONCLUSIONS
Non-ICU HAP is an important cause of hospital morbidity, observed most frequently in medical wards and elderly patients with severe underlying diseases. In this setting, S pneumoniae and Legionella sp should be considered in addition to other nosocomial pathogens; urinary antigen detection is useful in determining the prevalence of these microorganisms.
Sopena
Nieves
N
Infectious Diseases Unit, University Hospital Germans Trias i Pujol, Baldona (Barcelona), Spain. nsopena@ns.hugtip.scs.es
Sabrià
Miquel
M
D000368:Aged; D000942:Antigens, Bacterial / Q000032:analysis; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology; D005260:Female; D006801:Humans; D016952:Legionella pneumophila / Q000276:immunology; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000453:epidemiology* / Q000382:microbiology; D011446:Prospective Studies; D012307:Risk Factors; D013030:Spain; D013296:Streptococcus pneumoniae / Q000276:immunology
D000942:Antigens, Bacterial