A prospective comparison of nursing home-acquired pneumonia with hospital-acquired pneumonia in non-intubated elderly

• Published in: Respiratory medicine Vol. 102; no. 9; pp. 1287 - 1295
• Main Authors: Maruyama, T, Niederman, M.S, Kobayashi, T, Kobayashi, H, Takagi, T, D'Alessandro-Gabazza, C.N, Fujimoto, H, Gil Bernabe, P, Hirohata, S, Nakayama, S, Nishikubo, K, Yuda, H, Yamaguchi, A, Gabazza, E.C, Noguchi, T, Takei, Y, Taguchi, O
• Format: Journal Article
• Language: English
• Published: Oxford Elsevier Ltd 01.09.2008; Elsevier; Elsevier Limited
• Subjects: Aged; Aged, 80 and over; Bacteriology; Biological and medical sciences; Blood pressure; Chlamydophila Infections - epidemiology; Chlamydophila Infections - mortality; Cross Infection - epidemiology; Cross Infection - mortality; Disease; Drug resistance; Elderly; Female; General aspects; Homes for the Aged; Hospital Mortality; Hospitalization; Human infectious diseases. Experimental studies and models; Humans; Hypotheses; Infection Control; Infectious diseases; Influenza; Japan - epidemiology; Logistic Models; Logistics; Male; Medical sciences; Middle Aged; Mortality; Non-intubated patients; Nursing; Nursing Homes; Older people; Pneumology; Pneumonia; Pneumonia - epidemiology; Pneumonia - mortality; Prognosis; Prospective Studies; Pulmonary/Respiratory; Regression analysis; Respiratory system : syndromes and miscellaneous diseases; Risk Factors; Statistics, Nonparametric; Streptococcus infections; Japan; Pneumonia; Prognosis; Elderly; Non-intubated patients; Human; Lung disease; Nosocomial infection; Long stay; Respiratory disease; Acquired; Care; Prospective; Nursing home; Comparative study; Pneumology
• ISSN: 0954-6111; 1532-3064
• DOI: 10.1016/j.rmed.2008.03.027

Summary There are no prospective comparison of the etiology and clinical outcome between hospital-acquired pneumonia (HAP) and nursing home-acquired pneumonia (NHAP) in non-intubated elderly. This study prospectively evaluated the etiology of HAP and NHAP in non-intubated elderly. A prospective cohort study was carried out in a rural region of Japan where the population over 65 years of age represents 30% of the population. A total of 108 patients were enrolled. There were 33 patients with HAP and 75 with NHAP. Etiologic diagnosis was established in 78.8% of HAP and in 72% of NHAP patients. The most frequent pathogens were Chlamydophila pneumoniae followed by Streptococcus pneumoniae , Staphylococcus aureus and Influenza virus . The frequency of Streptococcus pneumoniae and Influenza virus was significantly higher, whereas the frequency of Staphylococcus aureus and Enterobacteriaceae was significantly lower in NHAP compared to HAP. Performance and nutritional status were significantly worse in patients with HAP than in those with NHAP. Hospital mortality was significantly lower in patients with NHAP compared to those with HAP. This study demonstrated that C. pneumoniae , Streptococcus pneumoniae , Staphylococcus aureus and Influenza virus are frequent causative agents of pneumonia in non-intubated elderly and that the responsible pathogens and clinical outcome differ between NHAP and HAP.