title: Microbial aetiology of healthcare associated pneumonia in Spain: a prospective, multicentre, case-control study.
abstract: BACKGROUND
  Healthcare-associated pneumonia (HCAP) is actually considered a subgroup of hospital-acquired pneumonia due to the reported high risk of multidrug-resistant pathogens in the USA. Therefore, current American Thoracic Society/Infectious Diseases Society of America guidelines suggest a nosocomial antibiotic treatment for HCAP. Unfortunately, the scientific evidence supporting this is contradictory.
  
  
  METHODS
  We conducted a prospective multicentre case-control study in Spain, comparing clinical presentation, outcomes and microbial aetiology of HCAP and community-acquired pneumonia (CAP) patients matched by age (±10 years), gender and period of admission (±10 weeks).
  
  
  RESULTS
  476 patients (238 cases, 238 controls) were recruited for 2 years from June 2008. HCAP cases showed significantly more comorbidities (including dysphagia), higher frequency of previous antibiotic use in the preceding month, higher pneumonia severity score and worse clinical status (Charslon and Barthel scores). While microbial aetiology did not differ between the two groups (HCAP and CAP: Streptococcus pneumoniae: 51% vs 55%; viruses: 22% vs 12%; Legionella: 4% vs 9%; Gram-negative bacilli: 5% vs 4%; Pseudomonas aeruginosa: 4% vs 1%), HCAP patients showed worse mortality rates (1-month: HCAP, 12%; CAP 5%; 1-year: HCAP, 24%; CAP, 9%), length of hospital stay (9 vs 7 days), 1-month treatment failure (5.5% vs 1.5%) and readmission rate (18% vs 11%) (p<0.05, each).
  
  
  CONCLUSIONS
  Despite a similar clinical presentation, HCAP was more severe due to patients' conditions (comorbidities) and showed worse clinical outcomes. Microbial aetiology of HCAP did not differ from CAP indicating that it is not related to increased mortality and in Spain most HCAP patients do not need nosocomial antibiotic coverage.
authors.affiliation: Servicio de Pneumologia, Hospital Clínic i Provincial de Barcelona, IDIBAPS, Barcelona, Spain.
authors.forename: Eva
authors.initials: E
authors.lastname: Polverino
authors.forename: Antoni
authors.initials: A
authors.lastname: Torres
authors.forename: Rosario
authors.initials: R
authors.lastname: Menendez
authors.forename: Catia
authors.initials: C
authors.lastname: Cillóniz
authors.forename: Jose Manuel
authors.initials: JM
authors.lastname: Valles
authors.forename: Alberto
authors.initials: A
authors.lastname: Capelastegui
authors.forename: M Angeles
authors.initials: MA
authors.lastname: Marcos
authors.forename: Inmaculada
authors.initials: I
authors.lastname: Alfageme
authors.forename: Rafael
authors.initials: R
authors.lastname: Zalacain
authors.forename: Jordi
authors.initials: J
authors.lastname: Almirall
authors.forename: Luis
authors.initials: L
authors.lastname: Molinos
authors.forename: Salvador
authors.initials: S
authors.lastname: Bello
authors.forename: Felipe
authors.initials: F
authors.lastname: Rodríguez
authors.forename: Josep
authors.initials: J
authors.lastname: Blanquer
authors.forename: Antonio
authors.initials: A
authors.lastname: Dorado
authors.forename: Noelia
authors.initials: N
authors.lastname: Llevat
authors.forename: Jordi
authors.initials: J
authors.lastname: Rello
mesh_terms: D000367:Age Factors; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016022:Case-Control Studies; D017714:Community-Acquired Infections / Q000188:drug therapy / Q000453:epidemiology*; D003428:Cross Infection / Q000188:drug therapy / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D011014:Pneumonia / Q000188:drug therapy / Q000453:epidemiology*; D011446:Prospective Studies; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D015996:Survival Rate / Q000639:trends
chemical_list: D000900:Anti-Bacterial Agents