title: Clinical characteristics of pneumonia in bedridden patients receiving home care: a 3-year prospective observational study.
abstract: BACKGROUND
  The aim of the study was to describe the epidemiology, clinical features, antimicrobial treatment, and outcomes of bedridden pneumonia patients receiving home healthcare.
  
  
  METHODS
  A 3-year prospective observational study of poor performance status (PS) 3-4 patients receiving long-term home healthcare and hospitalized at a single center with pneumonia between October 2010 and September 2013 was conducted, and their clinical characteristics were compared with non-bedridden community-acquired pneumonia (CAP) patients.
  
  
  RESULTS
  A total of 131 CAP patients with PS 3-4, and 400 CAP patients with PS 0-2 were evaluated. The PS 3-4 patients were older, and exhibited a higher frequency of underlying diseases. Aspiration was thought to be associated with pneumonia in 77.1% of the PS 3-4 patients. Streptococcus pneumoniae was the leading pathogen in both groups, whereas the frequency of streptococci and polymicrobial infections was higher in the PS 3-4 group. The incidence of multidrug-resistant pathogens such as methicillin-resistant Staphylococcus aureus (MRSA) or Pseudomonas aeruginosa was lower than in previous healthcare-associated pneumonia reports. The in-hospital mortality and recurrence rates were significantly higher in the PS 3-4 group than in the good PS group (17.6% vs. 6.0%, p < 0.001 and 15.3% vs. 7.5%, p = 0.008, respectively).
  
  
  CONCLUSIONS
  The clinical characteristics of pneumonia in poor PS patients were similar to healthcare-associated pneumonia (HCAP), except for the frequency of drug-resistant pathogens. Hence, it might be beneficial to categorize pneumonia in home residents with poor PS separately from pneumonia in CAP patients who were previously healthy or experienced mild comorbidities.
authors.affiliation: Department of Respiratory Medicine, Kurashiki Central Hospital, Ohara Memorial Kurashiki Central Healthcare Foundation, 1-1-1, Miwa, Kurashiki-city, Okayama 710-8602, Japan. Electronic address: ishidat@kchnet.or.jp.
authors.forename: Tadashi
authors.initials: T
authors.lastname: Ishida
authors.affiliation: Department of Respiratory Medicine, Kurashiki Central Hospital, Ohara Memorial Kurashiki Central Healthcare Foundation, 1-1-1, Miwa, Kurashiki-city, Okayama 710-8602, Japan.
authors.forename: Hiromasa
authors.initials: H
authors.lastname: Tachibana
authors.affiliation: Department of Respiratory Medicine, Kurashiki Central Hospital, Ohara Memorial Kurashiki Central Healthcare Foundation, 1-1-1, Miwa, Kurashiki-city, Okayama 710-8602, Japan.
authors.forename: Akihiro
authors.initials: A
authors.lastname: Ito
authors.affiliation: Department of Respiratory Medicine, Kurashiki Central Hospital, Ohara Memorial Kurashiki Central Healthcare Foundation, 1-1-1, Miwa, Kurashiki-city, Okayama 710-8602, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Ikeda
authors.affiliation: Department of Respiratory Medicine, Kurashiki Central Hospital, Ohara Memorial Kurashiki Central Healthcare Foundation, 1-1-1, Miwa, Kurashiki-city, Okayama 710-8602, Japan.
authors.forename: Kenjiro
authors.initials: K
authors.lastname: Furuta
authors.affiliation: Department of Respiratory Medicine, Kurashiki Central Hospital, Ohara Memorial Kurashiki Central Healthcare Foundation, 1-1-1, Miwa, Kurashiki-city, Okayama 710-8602, Japan.
authors.forename: Akihiro
authors.initials: A
authors.lastname: Nishiyama
authors.affiliation: Department of Respiratory Medicine, Kurashiki Central Hospital, Ohara Memorial Kurashiki Central Healthcare Foundation, 1-1-1, Miwa, Kurashiki-city, Okayama 710-8602, Japan.
authors.forename: Maki
authors.initials: M
authors.lastname: Noyama
authors.affiliation: Department of Respiratory Medicine, Kurashiki Central Hospital, Ohara Memorial Kurashiki Central Healthcare Foundation, 1-1-1, Miwa, Kurashiki-city, Okayama 710-8602, Japan.
authors.forename: Fumiaki
authors.initials: F
authors.lastname: Tokioka
authors.affiliation: Department of Respiratory Medicine, Kurashiki Central Hospital, Ohara Memorial Kurashiki Central Healthcare Foundation, 1-1-1, Miwa, Kurashiki-city, Okayama 710-8602, Japan.
authors.forename: Hiroshige
authors.initials: H
authors.lastname: Yoshioka
authors.affiliation: Department of Respiratory Medicine, Kurashiki Central Hospital, Ohara Memorial Kurashiki Central Healthcare Foundation, 1-1-1, Miwa, Kurashiki-city, Okayama 710-8602, Japan.
authors.forename: Machiko
authors.initials: M
authors.lastname: Arita
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001510:Bed Rest; D060085:Coinfection / Q000453:epidemiology / Q000382:microbiology; D017714:Community-Acquired Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D005260:Female; D006304:Health Status; D006699:Home Care Services; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus; D008875:Middle Aged; D011018:Pneumonia, Pneumococcal / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D011446:Prospective Studies; D011552:Pseudomonas Infections / Q000188:drug therapy / Q000453:epidemiology*; D011550:Pseudomonas aeruginosa; D012008:Recurrence; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000453:epidemiology*; D013997:Time Factors
chemical_list: D000900:Anti-Bacterial Agents
keywords: Aspiration; Community-acquired pneumonia; Healthcare-associated pneumonia; Home care; Performance status