Chest
ORIGINAL RESEARCHHEALTH-CARE-ASSOCIATED PNEUMONIAWhy Mortality Is Increased in Health-Care-Associated Pneumonia: Lessons From Pneumococcal Bacteremic Pneumonia
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Study Population
Patients admitted between January 1999 and June 2007 to an 800-bed teaching hospital (500 beds for acute care patients and 300 for long-term hospitalization) were prospectively identified by one of the authors (M. L.). All patients aged ≥ 18 years who received a diagnosis of pneumonia (fever, productive cough, chest pain, shortness of breath, and crackles on auscultation in addition to a chest radiograph interpreted as pneumonia), and whose blood cultures obtained within the first 48 h of
Results
During the study period, all consecutive patients with bacteremic pneumococcal pneumonia were identified at the ED. Twenty were excluded because of HIV infection. Forty-four (19%) had HCAP and 184 had CAP. Hospitalization in the previous 90 days (25 patients, 56.8%) was the most common condition in the HCAP cohort, with 16 (38.5%) patients admitted from long-term care facilities. Only eight were receiving cancer chemotherapy, and one patient was receiving hemodialysis. Six patients met more
Discussion
This article compares CAP with HCAP specifically in monomicrobial bacteremic pneumococcal pneumonia, and evaluates the implications of HCAP in the ICU. Our findings endorse the concept that patients with pneumococcal HCAP present significant differences in terms of demographics, severity of illness, and complications. These differences are not only of academic interest, since HCAP was associated with higher mortality. Interestingly, inappropriate therapy was uncommon when isolates were
Acknowledgments
Author contributions: Dr Rello: contributed to study design, analysis of data, writing the first draft, and creating the final version of the manuscript.
Dr Luján: contributed to study design, enrolling patients, recording variables, conducting follow-up, collecting samples, analyzing data, writing the first draft, and creating the final version of the manuscript.
Dr Gallego: contributed to study design, analysis of data, writing the first draft, and creating the final version of the manuscript.
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Funding/Support: This study was supported in part by CIBER enfermedades respiratorias (CIBERes) 06/06/36, AGAUR 2009/SGR/1226, FISS 08/0452, and FISS 04/1500. The Proyecto Corporativo de Neumonía (PROCORNEU) Study Group is supported by CIBERes, Instituto de Salud Carlos III.
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