[A multicenter prospective cohort study on risk factors for hospital-acquired pneumonia in the elderly].
OBJECTIVE
To investigate the incidence and the risk factors for hospital-acquired pneumonia (HAP) in the elderly in Shanghai.


METHODS
This was a multicenter prospective clinical cohort study. A total of 5299 patients more than 65 years old, admitted into 31 secondary or tertiary hospitals in Shanghai, were enrolled. Measurements of the demographic and potential risk factors reflecting illness severity, nutrition, drug exposure, surgery and ventilation were performed. Pneumonia was classified by the definition of Chinese Medical Association. Risk factors were analyzed by univariate Pearson Chi-squared test and multivariable logistic regression analysis with backward (Likelihood ratio).


RESULTS
Of the enrolled patients, 2805 male and 2494 female, 255 (4.81%) developed hospital-acquired pneumonia. The incidence was 46.75/1000 hospitalizations. Among them 38 died; and the rough mortality was 14.90%. The incidence of HAP was higher in ICU (21.43%), hematology (12.17%), chest surgery (11.41%), and respiratory medicine (7.92%) departments. The mean of acute physiology and chronic health evaluation (APACHE II) score was 8.3 +/- 3.4 (5 - 31). Multivariable logistic regression analysis with backward (Wald) method found that admission into secondary hospitals, admission into ICU, history of chronic obstructive pulmonary disease > or = 10 years, immunosuppression, administration of antibiotics, insertion of nasogastric tube, mechanical ventilation, administration of H-2 antagonists or antacid and < or = 7 d, central nervous system diseases, depressed level of consciousness, supine position, albumin < 35 g/L were independent risk factors of HAP in the elderly.


CONCLUSIONS
Hospital-acquired pneumonia in the elderly was the usual type of nosocomial infections. The risk factors identified from this study may prove useful to target future clinical interventions to prevent HAP in the elderly.
Deng
Zhi
Z
Shanghai Nosocomial Infection Control Centre, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
Hu
Bi-Jie
BJ
He
Li-Xian
LX
Gao
Xiao-Dong
XD
Li
Hua-Yin
HY
Chen
Xue-Hua
XH
Wang
Wen-Juan
WJ
Ren
Jin-Lan
JL
Han
Hong-Mei
HM
D000368:Aged; D002681:China / Q000453:epidemiology; D015331:Cohort Studies; D003428:Cross Infection / Q000453:epidemiology*; D005260:Female; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D011014:Pneumonia / Q000453:epidemiology*; D011446:Prospective Studies; D012307:Risk Factors