This Article Full Text Full Text (PDF) Other Versions of this Article: AAC.00851-07v1 51/10/3568    most recent Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Reprints and Permissions Copyright Information Books from ASM Press MicrobeWorld Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Micek, S. T. Articles by Kollef, M. H. Search for Related Content PubMed PubMed Citation Articles by Micek, S. T. Articles by Kollef, M. H.

 Previous Article  |  Next Article 

Antimicrobial Agents and Chemotherapy, October 2007, p. 3568-3573, Vol. 51, No. 10
0066-4804/07/$08.00+0     doi:10.1128/AAC.00851-07
Copyright © 2007, American Society for Microbiology. All Rights Reserved.

Health Care-Associated Pneumonia and Community-Acquired Pneumonia: a Single-Center Experience

Department of Pharmacy, Barnes-Jewish Hospital, St. Louis, Missouri,¹ Pulmonary and Critical Care Division, Washington University School of Medicine, St. Louis, Missouri,² BJC Health Care, Center for Health Care Quality and Effectiveness, St. Louis, Missouri³

Received 29 June 2007/ Returned for modification 24 July 2007/ Accepted 31 July 2007

Pneumonia occurring outside of the hospital setting has traditionally been categorized as community-acquired pneumonia (CAP). However, when pneumonia is associated with health care risk factors (prior hospitalization, dialysis, residing in a nursing home, immunocompromised state), it is now more appropriately classified as a health care-associated pneumonia (HCAP). The relative incidences of CAP and HCAP among patients requiring hospital admission is not well described. The objective of this retrospective cohort study, involving 639 patients with culture-positive CAP and HCAP admitted between 1 January 2003 and 31 December 2005, was to characterize the incidences, microbiology, and treatment patterns for CAP and HCAP among patients requiring hospital admission. HCAP was more common than CAP (67.4% versus 32.6%). The most common pathogens identified overall included methicillin-resistant Staphylococcus aureus (24.6%), Streptococcus pneumoniae (20.3%), Pseudomonas aeruginosa (18.8%), methicillin-sensitive Staphylococcus aureus (13.8%), and Haemophilus influenzae (8.5%). The hospital mortality rate was statistically greater among patients with HCAP than among those with CAP (24.6% versus 9.1%; P < 0.001). Administration of inappropriate initial antimicrobial treatment was statistically more common among HCAP patients (28.3% versus 13.0%; P < 0.001) and was identified as an independent risk factor for hospital mortality. Our study found that the incidence of HCAP was greater than that of CAP among patients with culture-positive pneumonia requiring hospitalization at Barnes-Jewish Hospital. Patients with HCAP were more likely to initially receive inappropriate antimicrobial treatment and had a greater risk of hospital mortality. Health care providers should differentiate patients with HCAP from those with CAP in order to provide more appropriate initial antimicrobial therapy.

Published ahead of print on 6 August 2007.

This article has been cited by other articles:

• Brito, V., Niederman, M. S. (2008). How can we improve the management and outcome of pneumonia in the elderly?. Eur Respir J 32: 12-14 [Full Text]  
• Kothe, H., Bauer, T., Marre, R., Suttorp, N., Welte, T., Dalhoff, K., the Competence Network for Community-Acquired Pneu, (2008). Outcome of community-acquired pneumonia: influence of age, residence status and antimicrobial treatment. Eur Respir J 32: 139-146 [Abstract] [Full Text]  
• Wardenburg, J. B., Schneewind, O. (2008). Vaccine protection against Staphylococcus aureus pneumonia. J. Exp. Med. 205: 287-294 [Abstract] [Full Text]