Resistant Pathogens and Antibiotic Resistance are Considerations for HCAP Patients

Healthcare-associated pneumonia (HCAP) has more similarities to nosocomial pneumonia than to community-acquired pneumonia (CAP). However, there have only been a few epidemiological studies of HCAP in South Korea. Ji Ye Jung, of the Division of Pulmonology and Critical Care Medicine at Yonsei University College of Medicine in Seoul, Korea, and colleagues, aimed to determine the differences between HCAP and CAP in terms of clinical features, pathogens and outcomes, and to clarify approaches for initial antibiotic management.

The researchers conducted a retrospective, observational study of 527 patients with HCAP or CAP who were hospitalized at Severance Hospital in South Korea between January and December 2008. Of these patients, 231 (43.8%) had HCAP, and 296 (56.2 percent) had CAP. Potentially drug-resistant (PDR) bacteria were more frequently isolated in HCAP than CAP (12.6 percent vs. 4.7 percent; P = 0.001), especially in the low-risk group of the PSI classes (41.2 percent vs. 13.9 percent; P = 0.027). In-hospital mortality was higher for HCAP than CAP patients (28.1percent vs. 10.8percent, P < 0.001), especially in the low-risk group of PSI classes (16.4 percent vs. 3.1 percent; P = 0.001). Moreover, tube feeding and prior hospitalization with antibiotic treatment within 90 days of pneumonia onset were significant risk factors for PDR pathogens, with odds ratios of 14.94 (95% CI 4.62-48.31; P < 0.001) and 2.68 (95% CI 1.32-5.46; P = 0.007), respectively.

Jung and colleagues conclude that for HCAP patients with different backgrounds, various pathogens and antibiotic resistance of should be considered, and careful selection of patients requiring broad-spectrum antibiotics is important when physicians start initial antibiotic treatments. Their research was published in BMC Infectious Diseases.

Reference: Jung JY, Park MS, Kim YS, Park BH, Kim SK, Chang J and Kang YA. Healthcare-associated pneumonia among hospitalized patients in a Korean tertiary hospital. BMC Infectious Diseases 2011, 11:61doi:10.1186/1471-2334-11-61