title: Nursing-home-acquired pneumonia in Germany: an 8-year prospective multicentre study.
abstract: OBJECTIVE
  To determine differences in aetiologies, initial antimicrobial treatment choices and outcomes in patients with nursing-home-acquired pneumonia (NHAP) compared with patients with community-acquired pneumonia (CAP), which is a controversial issue.
  
  
  METHODS
  Data from the prospective multicentre Competence Network for Community-acquired pneumonia (CAPNETZ) database were analysed for hospitalised patients aged ≥65 years with CAP or NHAP. Potential differences in baseline characteristics, comorbidities, physical examination findings, severity at presentation, initial laboratory investigations, blood gases, microbial investigations, aetiologies, antimicrobial treatment and outcomes were determined between the two groups.
  
  
  RESULTS
  Patients with NHAP presented with more severe pneumonia as assessed by CRB-65 (confusion, respiratory rate, blood pressure, 65 years and older) score than patients with CAP but received the same frequency of mechanical ventilation and less antimicrobial combination treatment. There were no clinically relevant differences in aetiology, with Streptococcus pneumoniae the most important pathogen in both groups, and potential multidrug-resistant pathogens were very rare (<5%). Only Staphylococcus aureus was more frequent in the NHAP group (n=12, 2.3% of the total population, 3.1% of those with microbial sampling compared with 0.7% and 0.8% in the CAP group, respectively). Short-term and long-term mortality in the NHAP group was higher than in the CAP group for patients aged ≥65 years (26.6% vs 7.2% and 43.8% vs 14.6%, respectively). However, there was no association between excess mortality and potential multidrug-resistant pathogens.
  
  
  CONCLUSIONS
  Excess mortality in patients with NHAP cannot be attributed to a different microbial pattern but appears to result from increased comorbidities, and consequently, pneumonia is frequently considered and managed as a terminal event.
authors: Thoraxzentrum Ruhrgebiet, Department of Respiratory and Infectious Diseases, EVK Herne and Augusta-Kranken-Anstalt Bochum, Germany. sewig@versanet.de
authors: Santiago
authors: S
authors: Ewig
authors: Benjamin
authors: B
authors: Klapdor
authors: Mathias W
authors: MW
authors: Pletz
authors: Gernot
authors: G
authors: Rohde
authors: Hartwig
authors: H
authors: Schütte
authors: Tom
authors: T
authors: Schaberg
authors: Torsten T
authors: TT
authors: Bauer
authors: Tobias
authors: T
authors: Welte
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000890:Anti-Infective Agents / Q000627:therapeutic use; D017714:Community-Acquired Infections / Q000188:drug therapy / Q000401:mortality; D015897:Comorbidity; D003428:Cross Infection / Q000175:diagnosis / Q000382:microbiology / Q000401:mortality / Q000635:transmission*; D004812:Epidemiologic Methods; D005260:Female; D005858:Germany / Q000453:epidemiology; D006707:Homes for the Aged / Q000706:statistics & numerical data*; D006801:Humans; D007251:Influenza, Human / Q000188:drug therapy / Q000401:mortality / Q000635:transmission; D008297:Male; D009735:Nursing Homes / Q000706:statistics & numerical data*; D018410:Pneumonia, Bacterial / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality / Q000635:transmission*; D011024:Pneumonia, Viral / Q000188:drug therapy / Q000401:mortality / Q000635:transmission; D016896:Treatment Outcome
chemical_list: D000890:Anti-Infective Agents