A Case-Control Study Assessing the Impact of Nonventilated Hospital-Acquired Pneumonia on Patient Outcomes.
BACKGROUND
Nonventilated hospital-acquired pneumonia (NVHAP) is a serious nosocomial infection that is increasingly attributed to antibiotic-resistant bacteria.


METHODS
This is a retrospective case-control study comparing patients with and those without NVHAP from January 1, 2014 to December 31, 2014 at Barnes-Jewish Hospital, a 1,300-bed urban academic medical center in St. Louis, Missouri.


RESULTS
One hundred seventy-four consecutive patients with NVHAP were enrolled. A random sample of 696 control patients matched by age, sex, race, and hospital admission date were selected from a total of 5,322 potential matched control subjects. NVHAP was pathogen-negative in 98 cases (56.3%). Respiratory viruses were identified in 42 patients (24.1%), gram-negative bacteria were seen in 25 patients (14.4%), and gram-positive bacteria were identified in 20 patients (11.5%). Individuals in whom NVHAP developed were more likely to die (15.5% vs 1.6%; P < .01), to require intensive care (56.3% vs 22.8%; P < .01) or mechanical ventilation (19.0% vs 3.9%; P < 0.01), and to have a longer hospital length of stay (15.9 days [range, 9.8-26.3 days] vs 4.4 days [range, 2.9-7.3 days]; P < 0.01). This case-control study identified a strong association between hospital mortality and NVHAP, with patients who acquired NVHAP having an 8.4 times greater odds of death (95% CI, 5.6-12.5).


CONCLUSIONS
The occurrence of NVHAP was associated with significant increases in mortality, the use of intensive care and mechanical ventilation, and hospital length of stay. We also found that respiratory viruses were an important cause of NVHAP. These findings suggest that efforts aimed at the successful prevention of NVHAP could improve patient outcomes and reduce health-care costs.
St. Louis College of Pharmacy, Department of Pharmacy Practice, St. Louis, MO. Electronic address: scott.micek@stlcop.edu.
Scott T
ST
Micek
St. Louis College of Pharmacy, Department of Pharmacy Practice, St. Louis, MO.
Bethany
B
Chew
BJC Healthcare, Center for Clinical Excellence, St. Louis, MO.
Nicholas
N
Hampton
Pulmonary and Critical Care Division, Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO.
Marin H
MH
Kollef
D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016022:Case-Control Studies; D003422:Critical Care; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D018432:Drug Resistance, Multiple; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D008923:Missouri / Q000453:epidemiology; D011014:Pneumonia / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D012121:Respiration, Artificial; D012189:Retrospective Studies; D012307:Risk Factors
D000900:Anti-Bacterial Agents
antibiotic resistance; outcomes; pneumonia