title: Healthcare-Associated Pneumonia among Hospitalized Patients: Is It Different from Community Acquired Pneumonia?
abstract: BACKGROUND
  The increasing number of outpatients with multidrug-resistant (MDR) pathogens has led to a new category of pneumonia, termed healthcare-associated pneumonia (HCAP). We determined the differences in etiology and outcomes between patients with HCAP and those with community-acquired pneumonia (CAP) to clarify the risk factors for HCAP mortality.
  
  
  METHODS
  A retrospective study comparing patients with HCAP and CAP at Jeju National University Hospital. The primary outcome was 30-day mortality.
  
  
  RESULTS
  A total of 483 patients (208 patients HCAP, 275 patients with CAP) were evaluated. Patients with HCAP were older than those with CAP (median, 74 years; interquartile range [IQR], 65-81 vs. median, 69 years; IQR, 52-78; p<0.0001). Streptococcus pneumoniae was the major pathogen in both groups, and MDR pathogens were isolated more frequently from patients with HCAP than with CAP (18.8% vs. 4.9%, p<0.0001). Initial pneumonia severity was greater in patients with HCAP than with CAP. The total 30-day mortality rate was 9.9% and was higher in patients with HCAP based on univariate analysis (16.3% vs. 5.1%; odds ratio (OR), 3.64; 95% confidence interval (CI), 1.90-6.99; p<0.0001). After adjusting for age, sex, comorbidities, and initial severity, the association between HCAP and 30-day mortality became non-significant (OR, 1.98; 95% CI, 0.94-4.18; p=0.167).
  
  
  CONCLUSIONS
  HCAP was a common cause of hospital admissions and was associated with a high mortality rate. This increased mortality was related primarily to age and initial clinical vital signs, rather than combination antibiotic therapy or type of pneumonia.
authors.affiliation: Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea.
authors.forename: Gil Myung
authors.initials: GM
authors.lastname: Seong
authors.affiliation: Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea.
authors.forename: Miok
authors.initials: M
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea.
authors.forename: Jaechun
authors.initials: J
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea.
authors.forename: Jong Hoo
authors.initials: JH
authors.lastname: Lee
authors.affiliation: Department of Radiology, Jeju National University School of Medicine, Jeju, Korea.
authors.forename: Sun Young
authors.initials: SY
authors.lastname: Jeong
authors.affiliation: Department of Anesthesia and Pain Medicine, Jeju National University School of Medicine, Jeju, Korea.
authors.forename: Yunsuk
authors.initials: Y
authors.lastname: Choi
authors.affiliation: Department of Emergency Medicine, Jeju National University School of Medicine, Jeju, Korea.
authors.forename: Woo Jeong
authors.initials: WJ
authors.lastname: Kim
keywords: Anti-Bacterial Agents; Drug Resistance; Mortality; Pneumonia