title: Epidemiology, antibiotic therapy and clinical outcomes of healthcare-associated pneumonia in critically ill patients: a Spanish cohort study.
abstract: OBJECTIVE
  Information about healthcare-associated pneumonia (HCAP) in critically ill patients is scarce.
  
  
  METHODS
  This prospective study compared clinical presentation, outcomes, microbial etiology, and treatment of HCAP, community-acquired pneumonia (CAP), and immunocompromised patients (ICP) with severe pneumonia admitted to 34 Spanish ICUs.
  
  
  RESULTS
  A total of 726 patients with pneumonia (449 CAP, 133 HCAP, and 144 ICP) were recruited during 1 year from April 2011. HCAP patients had more comorbidities and worse clinical status (Barthel score). HCAP and ICP patients needed mechanical ventilation and tracheotomy more frequently than CAP patients. Streptococcus pneumoniae was the most frequent pathogen in all three groups (CAP, 34.2 %; HCAP, 19.5 %; ICP, 23.4 %; p = 0.001). The overall incidence of Gram-negative pathogens, methicillin-resistant Staphylococcus aureus (MRSA), and Pseudomonas aeruginosa was low, but higher in HCAP and ICP patients than CAP. Empirical treatment was in line with CAP guidelines in 73.5 % of patients with CAP, in 45.5 % of those with HCAP, and in 40 % of those with ICP. The incidence of inappropriate empirical antibiotic therapy was 6.5 % in CAP, 14.4 % in HCAP, and 21.8 % in ICP (p < 0.001). Mortality was highest in ICP (38.6 %) and did not differ between CAP (18.4 %) and HCAP (21.2 %).
  
  
  CONCLUSIONS
  HCAP accounts for one-fifth of cases of severe pneumonia in patients admitted to Spanish ICUs. The empirical antibiotic therapy recommended for CAP would be appropriate for 90 % of patients with HCAP in our population, and consequently the decision to include coverage of multidrug-resistant pathogens for HCAP should be cautiously judged in order to prevent the overuse of antimicrobials.
authors.affiliation: Area de Patología Crítica, Critical Care Department, Hospital de Sabadell, Corporació Sanitaria Universitaria Parc Taulí, Parc Taulí s/n, Sabadell, Spain, jvalles@tauli.cat.
authors.forename: Jordi
authors.initials: J
authors.lastname: Vallés
authors.forename: Ignacio
authors.initials: I
authors.lastname: Martin-Loeches
authors.forename: Antoni
authors.initials: A
authors.lastname: Torres
authors.forename: Emili
authors.initials: E
authors.lastname: Diaz
authors.forename: Iratxe
authors.initials: I
authors.lastname: Seijas
authors.forename: Maria José
authors.initials: MJ
authors.lastname: López
authors.forename: Pau
authors.initials: P
authors.lastname: Garro
authors.forename: Carlos
authors.initials: C
authors.lastname: Castillo
authors.forename: Jose
authors.initials: J
authors.lastname: Garnacho-Montero
authors.forename: María del Mar
authors.initials: Mdel M
authors.lastname: Martin
authors.forename: Maria Victoria
authors.initials: MV
authors.lastname: de la Torre
authors.forename: Pedro
authors.initials: P
authors.lastname: Olaechea
authors.forename: Catia
authors.initials: C
authors.lastname: Cilloniz
authors.forename: Jordi
authors.initials: J
authors.lastname: Almirall
authors.forename: Fernando
authors.initials: F
authors.lastname: García
authors.forename: Roberto
authors.initials: R
authors.lastname: Jiménez
authors.forename: Estrella
authors.initials: E
authors.lastname: Seoane
authors.forename: Cruz
authors.initials: C
authors.lastname: Soriano
authors.forename: Eduard
authors.initials: E
authors.lastname: Mesalles
authors.forename: Pilar
authors.initials: P
authors.lastname: Posada
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D017714:Community-Acquired Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D016638:Critical Illness; D003428:Cross Infection / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology*; D011018:Pneumonia, Pneumococcal / Q000453:epidemiology; D013030:Spain / Q000453:epidemiology; D013296:Streptococcus pneumoniae; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents