title: Nursing home-acquired pneumonia presenting at the emergency department.
abstract: Nursing home-acquired pneumonia (NHAP) is one of the most common infections arising amongst nursing home residents, and its incidence is expected to increase as population ages. The NHAP recommendation for empiric broad-spectrum antibiotic therapy, arising from the concept of healthcare-associated pneumonia, has been challenged by recent studies reporting low rates of multidrug-resistant (MDR) bacteria. This single center study analyzes the results of NHAP patients admitted through the Emergency Department (ED) at a tertiary center during the year 2010. There were 116 cases, male gender corresponded to 34.5 % of patients and median age was 84 years old (IQR 77-90). Comorbidities were present in 69.8 % of cases and 48.3 % of patients had used healthcare services during the previous 90 days. In-hospital mortality rate was 46.6 % and median length-of-stay was 9 days. Severity assessment at the Emergency Department provided CURB65 index score and respective mortality (%) results: zero: n = 0; one: n = 7 (0 %); two: n = 18 (38.9 %); three: n = 26 (38.5 %); four: n = 30 (53.3 %); and five; n = 22 (68.2 %); and sepsis n = 50 (34.0 %), severe sepsis n = 43 (48.8 %) and septic shock n = 22 (72.7 %). Significant risk factors for in-hospital mortality in multivariate analysis were polypnea (p = 0.001), age ≥ 75 years (p = 0.02), and severe sepsis or shock (p = 0.03) at the ED. Microbiological testing in 78.4 % of cases was positive in 15.4 % (n = 15): methicillin-resistant Staphylococcus aureus (26.7 %), Pseudomonas aeruginosa (20.0 %), S. pneumoniae (13.3 %), Escherichia coli (13.3 %), others (26.7 %); the rate of MDR bacteria was 53.3 %. This study reveals high rates of mortality and MDR bacteria among NHAP hospital admissions supporting the use of empirical broad-spectrum antibiotic therapy in these patients.
authors.affiliation: Intensive Care Unit, Hospital Curry Cabral, CHLC, Lisbon, Portugal. rui.pereira@mail.com.
authors.forename: Rui
authors.identifier: http://orcid.org/0000-0002-3010-8384
authors.initials: R
authors.lastname: Pereira
authors.affiliation: Medicina Interna 4, Hospital Santa Marta, CHLC, Lisbon, Portugal.
authors.forename: Sara
authors.initials: S
authors.lastname: Oliveira
authors.affiliation: Medicina Interna 4, Hospital Santa Marta, CHLC, Lisbon, Portugal.
authors.forename: André
authors.initials: A
authors.lastname: Almeida
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use; D015331:Cohort Studies; D017714:Community-Acquired Infections / Q000453:epidemiology* / Q000401:mortality; D004636:Emergency Service, Hospital / Q000458:organization & administration / Q000706:statistics & numerical data; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000472:pathogenicity; D009735:Nursing Homes / Q000458:organization & administration* / Q000706:statistics & numerical data; D011014:Pneumonia / Q000453:epidemiology* / Q000382:microbiology; D011174:Portugal / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents
keywords: CURB65; Emergency department; Long-term; Nursing home; Pneumonia; Sepsis