title: Clinical characteristics of health care-associated pneumonia in a Korean teaching hospital.
abstract: BACKGROUND
  Health care-associated pneumonia (HCAP) has been proposed as a new category of respiratory infection. ATS/IDSA guidelines state that all patients with HCAP should receive empirical therapy directed at multidrug-resistant pathogens. However, recent data from other countries have reported a different picture of HCAP.
  
  
  METHODS
  We conducted a retrospective observational study of patients with HCAP and CAP who were hospitalized through the emergency department in January-December 2008 at Samsung Medical Center, Seoul, Korea, and compared clinical characteristics, severity, distribution of pathogen, and outcomes.
  
  
  RESULTS
  In total, 345 patients hospitalized with pneumonia were eligible, 182 (52.8%) with HCAP and 163 (47.2%) with CAP. Patients with HCAP had greater comorbidity and higher Pneumonia Severity Index (PSI) score (P < 0.001). Although Streptococcus pneumoniae was the most frequently isolated pathogen in HCAP and CAP patients, the occurrence of potentially drug-resistant pathogens (29.3% vs. 13.0%; P = 0.044) and inappropriate initial antimicrobial treatment (24.6% vs. 8.7%; P = 0.032) were significantly higher in HCAP patients. Patients with HCAP had a longer duration of hospital stay (13 [8-18] vs. 8 [6-12] days; P < 0.001), and higher in-hospital mortality (19.2% vs. 7.4%; P = 0.001). In a multiple logistic regression analysis, however, in-hospital mortality was independently associated with higher PSI class (OR 2.82, 95% CI 1.19-6.70) and ICU admission (OR 15.37, 95% CI 3.58-66.05).
  
  
  CONCLUSIONS
  Severity of illness, rather than type of pneumonia, was the main predicting factor for in-hospital mortality among patients with pneumonia hospitalized through the emergency department.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors.forename: Hye Kyeong
authors.initials: HK
authors.lastname: Park
authors.forename: Jae-Uk
authors.initials: JU
authors.lastname: Song
authors.forename: Sang-Won
authors.initials: SW
authors.lastname: Um
authors.forename: Won-Jung
authors.initials: WJ
authors.lastname: Koh
authors.forename: Gee Young
authors.initials: GY
authors.lastname: Suh
authors.forename: Man Pyo
authors.initials: MP
authors.lastname: Chung
authors.forename: Hojoong
authors.initials: H
authors.lastname: Kim
authors.forename: O Jung
authors.initials: OJ
authors.lastname: Kwon
authors.forename: Kyeongman
authors.initials: K
authors.lastname: Jeon
mesh_terms: D017714:Community-Acquired Infections / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality; D003428:Cross Infection / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality*; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D011014:Pneumonia / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality*; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013296:Streptococcus pneumoniae / Q000302:isolation & purification / Q000472:pathogenicity