Should nursing home-acquired pneumonia be treated as nosocomial pneumonia?
OBJECTIVE
It is contentious whether nursing home-acquired pneumonia (NHAP) should be treated as community-acquired pneumonia (CAP) or health care-associated pneumonia. This study aimed to compare NHAP with CAP, and to examine whether multidrug-resistant (MDR) bacteria were significantly more common in NHAP than CAP.


METHODS
A prospective, observational cohort study


METHODS
The medical unit of a tertiary teaching hospital


METHODS
Patients 65 years and older, hospitalized for CAP and NHAP confirmed by radiographs from October 2009 to September 2010


METHODS
Demographic characteristics, Katz score, Charlson comorbidity index (CCI), pneumonia severity (CURB score), microbiology, and clinical outcomes were measured.


RESULTS
A total of 488 patients were recruited and 116 (23.8%) patients were nursing home residents. Compared with patients with CAP, patients with NHAP were older and had more comorbidities and higher functional dependence level. A larger proportion of patients with NHAP had severe pneumonia (CURB ≥2) than patients with CAP (30.2% vs 20.7%, P = .034). Similar percentages of patients had identified infective causes in the CAP and NHAP groups (27.7% vs 29.3%, P = .734). Viral infection accounted for more than half (55.9%) of NHAP, whereas bacterial infection was the most frequent (69.9%) cause of CAP. MDR bacteria were found in 6 patients of all study subjects. Nursing home residence and history of MDR bacterial infection were risk factors for MDR bacterial pneumonia, which had more severe pneumonia (CURB ≥2). Logistic regression analysis was limited by the small number of patients with MDR bacterial pneumonia.


CONCLUSIONS
In both CAP and NHAP, MDR bacterial infections were uncommon. Most cases of NHAP were caused by unknown etiology or viral pathogens. We suggest that NHAP should not be treated as nosocomial infection. The empirical treatment of broad-spectrum antibiotics in NHAP should be reserved for patients with severe pneumonia or at high risk of MDR bacterial infection.
Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, HKSAR, China. hmma@cuhk.edu.hk
Hon Ming
HM
Ma
Jenny Lee Shun
JL
Wah
Jean
J
Woo
D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001419:Bacteria / Q000145:classification / Q000302:isolation & purification; D015331:Cohort Studies; D017714:Community-Acquired Infections / Q000188:drug therapy; D003428:Cross Infection / Q000175:diagnosis / Q000188:drug therapy*; D024901:Drug Resistance, Multiple, Bacterial / Q000187:drug effects; D005260:Female; D006723:Hong Kong; D006801:Humans; D008297:Male; D009735:Nursing Homes; D011014:Pneumonia / Q000175:diagnosis / Q000188:drug therapy*; D011446:Prospective Studies
D000900:Anti-Bacterial Agents