title: Facility characteristics as independent prognostic factors of nursing home-acquired pneumonia.
abstract: OBJECTIVE
  Recently, the incidence of nursing home-acquired pneumonia (NHAP) has been increasing and is now the leading cause of death among nursing home residents. This study was performed to identify risk factors associated with NHAP mortality, focusing on facility characteristics.
  
  
  METHODS
  Data on all patients ≥ 70 years of age admitted with newly diagnosed pneumonia were reviewed. To compare the quality of care in nursing facilities, the following three groups were defined: patients who acquired pneumonia in the community, care homes, and care hospitals. In these patients, 90-day mortality was compared.
  
  
  RESULTS
  Survival analyses were performed in 282 patients with pneumonia. In the analyses, 90-day mortality was higher in patients in care homes (12.2%, 40.3%, and 19.6% in community, care homes, and care hospitals, respectively). Among the 118 NHAP patients, residence in a care home, structural lung diseases, treatment with inappropriate antimicrobial agents for accompanying infections, and a high pneumonia severity index score were risk factors associated with higher 90-day mortality. However, infection by potentially drug-resistant pathogens was not important.
  
  
  CONCLUSIONS
  Unfavorable institutional factors in care homes are important prognostic factors for NHAP.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Myongji Hospital, Seonam University College of Medicine, Goyang, Korea.
authors.forename: Che Wan
authors.initials: CW
authors.lastname: Lim
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Myongji Hospital, Seonam University College of Medicine, Goyang, Korea.
authors.forename: Younghoon
authors.initials: Y
authors.lastname: Choi
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Myongji Hospital, Seonam University College of Medicine, Goyang, Korea.
authors.forename: Chang Hyeok
authors.initials: CH
authors.lastname: An
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Myongji Hospital, Seonam University College of Medicine, Goyang, Korea.
authors.forename: Sang Joon
authors.initials: SJ
authors.lastname: Park
authors.affiliation: Geriatric Center, Department of Family Medicine, Department of Internal Medicine, International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, Korea.
authors.forename: Hee-Jin
authors.initials: HJ
authors.lastname: Hwang
authors.affiliation: Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, Korea.
authors.forename: Jae Ho
authors.initials: JH
authors.lastname: Chung
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Myongji Hospital, Seonam University College of Medicine, Goyang, Korea.
authors.forename: Joo-Won
authors.initials: JW
authors.lastname: Min
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002423:Cause of Death; D003428:Cross Infection / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality*; D005260:Female; D006707:Homes for the Aged; D006761:Hospitals; D006801:Humans; D057970:Inappropriate Prescribing; D053208:Kaplan-Meier Estimate; D008297:Male; D009735:Nursing Homes; D018410:Pneumonia, Bacterial / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents
keywords: Nursing homes; Pneumonia; Prognosis
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