title: A worldwide perspective of nursing home-acquired pneumonia compared with community-acquired pneumonia.
abstract: BACKGROUND
  Nursing home-acquired pneumonia (NHAP) is the leading cause of death among long-term care patients and the second most common cause of transfers to acute care facilities. The aim of this study was to characterize the incidence, microbiology, and outcomes for hospitalized patients with community-acquired pneumonia (CAP) and NHAP.
  
  
  METHODS
  A secondary analysis of 5,160 patients from the Community-Acquired Pneumonia Organization database was performed. World regions were defined as the United States and Canada (I), Latin America (II), and Europe (III).
  
  
  RESULTS
  From a total of 5,160 hospitalized patients with CAP, NHAP was identified in 287 (5.6%) patients. Mean age was 80 y. NHAP distribution by region was 6% in region I, 3% in region II, and 7% in region III. Subjects with NHAP had higher frequencies of neurological disease, diabetes mellitus, congestive heart failure, and renal failure than did subjects with CAP (P < .001). ICU admission was required in 32 (12%) subjects. Etiology was defined in 68 (23%) subjects with NHAP and 1,300 (27%) with CAP. The most common pathogens identified in NHAP included Streptococcus pneumoniae (31%), Staphylococcus species (31%), and Pseudomonas aeruginosa (7%). Presentation of NHAP more frequently included pleural effusions (34% vs 21%, P < .001) and multilobar involvement (31% vs 24%, P < .001). Thirty-day hospital mortality was statistically greater among subjects with NHAP than among those with CAP (42% vs 18%, P < .001).
  
  
  CONCLUSIONS
  Worldwide, only a very small proportion of hospitalized patients with CAP present with NHAP; the poor outcomes for these patients may be due primarily to a higher number of comorbidities compared with patients without NHAP.
authors.affiliation: Third Respiratory Department, Sotiria Chest Hospital, Athens, Greece. mliapikou@yahoo.com.
authors.forename: Adamantia
authors.initials: A
authors.lastname: Liapikou
authors.affiliation: Respiratory Disease Department, Hospital Clinic, University of Barcelona and the Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Barcelona, Spain.
authors.forename: Eva
authors.initials: E
authors.lastname: Polverino
authors.affiliation: Respiratory Disease Department, Hospital Clinic, University of Barcelona and the Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Barcelona, Spain.
authors.forename: Catia
authors.initials: C
authors.lastname: Cilloniz
authors.affiliation: Infectious Disease Department, University of Louisville, Louisville, Kentucky.
authors.forename: Paulo
authors.initials: P
authors.lastname: Peyrani
authors.affiliation: Infectious Disease Department, University of Louisville, Louisville, Kentucky.
authors.forename: Julio
authors.initials: J
authors.lastname: Ramirez
authors.affiliation: Pneumology Department, Hospital Universitario La Fe, Valencia, Spain.
authors.forename: Rosario
authors.initials: R
authors.lastname: Menendez
authors.affiliation: Respiratory Disease Department, Hospital Clinic, University of Barcelona and the Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Barcelona, Spain.
authors.forename: Antoni
authors.initials: A
authors.lastname: Torres
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002170:Canada; D017714:Community-Acquired Infections / Q000453:epidemiology* / Q000382:microbiology; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology; D016208:Databases, Factual; D005060:Europe; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007843:Latin America; D008297:Male; D008875:Middle Aged; D009735:Nursing Homes; D017063:Outcome Assessment, Health Care; D011014:Pneumonia / Q000453:epidemiology* / Q000382:microbiology; D014481:United States
keywords: clinical epidemiology; nursing homes; pneumonia; quality of life; respiratory infections