title: Clinical and microbiological features of patients admitted to the intensive care unit with nursing and healthcare-associated pneumonia.
abstract: OBJECTIVE
  To evaluate clinical and microbiological features in patients with nursing and healthcare-associated pneumonia (NHCAP), admitted to the intensive care unit (ICU).
  
  
  METHODS
  Demographic, clinical and microbiological data were retrospectively reviewed from patients with NHCAP admitted to a respiratory ICU. Patients were categorized into one of four NHCAP groups: (A) residence in a long-term nursing-home setting or healthcare home; (B) hospital discharge in the preceding 90 days; (C) elderly or physically disabled patients who stay at home but require healthcare; (D) continuously receiving outpatient endovascular therapy including chronic dialysis, anticancer drugs, and immunosuppressants. Pneumonia severity index (PSI), CURB-65, duration of ICU stay and 30-day mortality were evaluated.
  
  
  RESULTS
  Out of 428 patients reviewed (male, 67.1%; mean age, 71.2 ± 11.9 years), 30-day mortality was 25.5%, and duration of ICU stay was 13.8 ± 13.3 days. Mortality rate was not significantly different between the four NHCAP groups; duration of ICU stay was significantly longer in groups C and D. PSI score, serum HCO3(-) level, duration of ICU stay, extended spectrum β-lactamase (ESBL)-producing Klebsiella pneumoniae and multidrug resistant (MDR) Acinetobacter baumannii were significantly associated with 30-day mortality.
  
  
  CONCLUSIONS
  ESBL-producing K. pneumoniae, MDR A. baumannii and PSI score should be considered in ICU patients with NHCAP.
authors.affiliation: Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea.
authors.forename: Myoung Kyu
authors.initials: MK
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea.
authors.forename: Sang-Ha
authors.initials: SH
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea.
authors.forename: Suk Joong
authors.initials: SJ
authors.lastname: Yong
authors.affiliation: Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea.
authors.forename: Kye Chul
authors.initials: KC
authors.lastname: Shin
authors.affiliation: Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea.
authors.forename: Hyeon Cheol
authors.initials: HC
authors.lastname: Park
authors.affiliation: Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea.
authors.forename: Jiwon
authors.initials: J
authors.lastname: Choi
authors.affiliation: Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea.
authors.forename: Yeun Seoung
authors.initials: YS
authors.lastname: Choi
authors.affiliation: Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea.
authors.forename: Jae Ho
authors.initials: JH
authors.lastname: Seong
authors.affiliation: Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea.
authors.forename: Ye-Ryung
authors.initials: YR
authors.lastname: Jung
authors.affiliation: Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea wonylee@yonsei.ac.kr.
authors.forename: Won-Yeon
authors.initials: WY
authors.lastname: Lee
mesh_terms: D000151:Acinetobacter Infections / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D003422:Critical Care; D003428:Cross Infection / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007710:Klebsiella Infections / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009732:Nursing Care; D018410:Pneumonia, Bacterial / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality; D012124:Respiratory Care Units; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents
keywords: Healthcare-associated; intensive care unit; mortality; multidrug resistant; pneumonia