title: Prior pneumococcal and influenza vaccinations and in-hospital outcomes for community-acquired pneumonia in elderly veterans.
abstract: BACKGROUND
  Studies of adults hospitalized for community-acquired pneumonia (CAP) reported better outcomes associated with prior pneumococcal vaccination (PV), suggesting potential additional benefits of PV in hospitalized CAP patients. Influenza (flu) vaccination (FV) could independently/additively improve CAP outcomes in hospitalized patients.
  
  
  OBJECTIVE
  To examine the effect of prior PV and FV on in-hospital outcomes in elderly veterans hospitalized for CAP.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  A total of 6,723 elderly veterans who were admitted to Veterans Affairs hospitals for CAP between October 1, 2002 and September 30, 2003.
  
  
  METHODS
  PV in the 5 years and FV in the 1 year before admission.
  
  
  METHODS
  The association of prior PV and/or FV with inpatient mortality and length of stay (LOS) (primary) and risk of any bacteremia and respiratory complications (secondary) were assessed using logistic regressions and generalized linear model, controlling for patient demographic and clinical characteristics.
  
  
  RESULTS
  Prior PV alone was not associated with shortened LOS, or reduced risk of inpatient mortality or respiratory complications. Lower risk of bacteremia was associated with prior PV (odds ratio: 0.66; 95% confidence interval [CI]: 0.48-0.90). After adjusting for patients' characteristics, risk of inpatient mortality was not statistically significantly different across the vaccination groups, but having had both PV and FV before CAP admission was associated with a 10% reduction in LOS (95% CI: 0.86-0.95) compared to having had neither vaccinations.
  
  
  CONCLUSIONS
  Significant survival benefit and improved in-hospital outcomes may not be expected among CAP-hospitalized elderly patients with prior PV alone. However, having both PV and FV before CAP admission may reduce LOS.
authors: Division of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences College of Pharmacy, Little Rock, Arkansas; Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, Arkansas.
authors: Chenghui
authors: C
authors: Li
authors: Paul O
authors: PO
authors: Gubbins
authors: Guoqing J
authors: GJ
authors: Chen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017714:Community-Acquired Infections / Q000453:epidemiology*; D005260:Female; D017052:Hospital Mortality; D006787:Hospitals, Veterans; D006801:Humans; D007252:Influenza Vaccines / Q000008:administration & dosage*; D007902:Length of Stay; D008297:Male; D016017:Odds Ratio; D022242:Pneumococcal Vaccines / Q000008:administration & dosage*; D011018:Pneumonia, Pneumococcal / Q000453:epidemiology*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012959:Socioeconomic Factors
chemical_list: D007252:Influenza Vaccines; D022242:Pneumococcal Vaccines