title: Clinical characteristics and outcome of healthcare associated pneumonia in Turkey.
abstract: BACKGROUND
  Pneumonia in cases with preceding hospitalization, hemodialysis, intravenous therapy, wound care, or chemotherapy within the prior 30 days and residence in nursing homes are defined as healthcare associated pneumonia (HCAP). The aim of this study was to compare the demographic and laboratory data, isolated causative agents and prognosis of patients with community-acquired pneumonia (CAP) and HCAP in a large population in Turkey.
  
  
  METHODS
  The data of 785 cases (average age 65.3 ± 16.4, 530 male) registered to Turkish Thoracic Society Respiratory Infections Study Group CAP database (TURCAP) were examined. The demographic data, clinical history, pneumonia severity scores (PSI), laboratory and radiologic findings of the CAP and HCAP patients were compared.
  
  
  RESULTS
  Out of 785 cases, 207 (26.4%) were diagnosed with HCAP and 578 (73.6%) with CAP. Among HCAP cases, 140/207 (67.6%) had preceding hospitalization in the last 90 days, 28/207 (13.5%) were on a hemodialysis program during the previous 30 days and 22/207 (10.6%) were staying in nursing homes. Patients with HCAP more frequently had comorbidities (93.2% vs. 81.6%; p= 0.001) and higher PSI scores (103.9 ± 37.2 vs. 94.6 ± 35.4; p= 0.002) compared to patients with CAP. A causative microorganism was isolated in only 12.1% (70/578) of CAP and 14.5% (30/207) of HCAP patients. The length of stay in hospital was higher in HCAP than CAP (8.6 ± 5.5 vs. 7.5 ± 6.1 days, p= 0.03); however the rates of treatment failure, intensive care unit admission and mortality were similar.
  
  
  CONCLUSIONS
  In comparison to CAP, HCAP patients tend to have more severe disease, despite have no difference in mortality. The current criteria for HCAP do not predict worse clinical outcomes. Further work is required to define local risk factors for multidrug-resistant pathogens.
authors.affiliation: Clinic of Chest Diseases, Adiyaman State Hospital, Adiyaman, Turkey. canangunduz@yahoo.com.
authors.forename: Canan
authors.initials: C
authors.lastname: Gündüz
authors.forename: Mehmet Sezai
authors.initials: MS
authors.lastname: Taşbakan
authors.forename: Abdullah
authors.initials: A
authors.lastname: Sayıner
authors.forename: Aykut
authors.initials: A
authors.lastname: Çilli
authors.forename: Oğuz
authors.initials: O
authors.lastname: Kılınç
authors.forename: Ayşın
authors.initials: A
authors.lastname: Şakar Coşkun
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017714:Community-Acquired Infections / Q000188:drug therapy / Q000453:epidemiology*; D015897:Comorbidity; D003428:Cross Infection / Q000188:drug therapy / Q000453:epidemiology*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000188:drug therapy / Q000453:epidemiology*; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D014421:Turkey / Q000453:epidemiology