363. Patients with Characteristics of both CAP and HCAP, an Overlooked Risk Group
Session: Poster Abstract Session: Community and Healthcare Acquired Pneumonia - Epidemiology
Friday, October 21, 2011
Room: Poster Hall B1
Background: Community-acquired pneumonia (CAP) is a common infection which can be severe. A recent addition to the classification of pneumonia is healthcare-associated pneumonia (HCAP), which partially overlaps CAP.

Methods: Prospective population-based study for 12 months at Landspitali University Hospital, Iceland, from December 2008-November 2009. The hospital encompasses 70% of all hospital beds in Iceland. Consecutive adult patients admitted with pneumonia were offered to participate in the study; an estimated 94% of all eligible patients participated. Patients with admission to hospital within the preceding 14 days were excluded. All patients underwent a structured interview and etiologic testing on admission. Clinical data were subsequently collected from the medical records with respect to treatment and outcomes. Patients were classified as having CAP or HCAP, or fulfilling criteria for both.

Results: 373 patients were admitted and considered to have CAP or HCAP. 236 patients fulfilled only CAP criteria and 60 fulfilled only HCAP criteria. In addition 77 patients fulfilled criteria for both CAP and HCAP and constitute the overlap group. A comparison of these groups is provided below:

 

CAP

n=239

HCAP

n=60

Overlap group

n=77

p-value*

Age, mean [95% CI]

59.9 [57.2-62.5]

66.7 [62.9-70.45]

72.2 [68.6-76.5]

<0.001

APACHE II, mean [95% CI]

8.3 [7.7-9.0]

13.4 [12.1-14.8]

12.0 [10.7-13.3]

<0.001

Length of stay (active)

7.4 [6.7-8.1]

8.6 [7.3-9.9]

7.9 [7.0-8.9]

0.04

In-house mortality

3(1.3%)

7(11.7%)

7 (9.1%)

<0.001

Etiology found

45.3%

38.3%

42.9%

0.61

Etiology:

 

 

 

 

  S. pneumoniae

12.7%

16.7%

15.6%

0.66

  M. pneumoniae

12.7%

1.7%

6.5%

0.02

  S. aureus

2.1%

0%

3.9%

0.30

*Statistical significance was determined at a p value of ≤0.05

Conclusion: Up to one fourth of patients fulfilling traditional criteria for CAP also fulfill some criteria for HCAP. Patients in this group have a worse prognosis, longer length of stay and higher mortality. They can potentially be misclassified on admission.


Subject Category: N. Hospital-acquired and surgical infections, infection control, and health outcomes including general public health and health services research

Agnar Bjarnason, MD1,2, Janus F. Gudnason, MD3, Hilmir Asgeirsson, MD1, Kristinn L. Hallgrimsson, MD4, Berglind Kristjansdottir2, Gunnsteinn Haraldsson, PhD5, Olafur Baldursson, MD, PhD6, Karl G. Kristinsson, MD, PhD5 and Magnus Gottfredsson, MD, PhD1,7, (1)Infectious Diseases, Landspitali University Hospital, Reykjavik, Iceland, (2)University of Iceland, Reykjavik, Iceland, (3)Emergency Medicine, Landspitali University Hospital, Reykjavik, Iceland, (4)Medicine, Landspitali University Hospital, Reykjavik, Iceland, (5)Clinical Microbiology, Landspitali University Hospital, Reykjavik, Iceland, (6)Pulmonary Medicine, Landspitali University Hospital, Reykjavik, Iceland, (7)University of Iceland Medical School, Reykjavik, Iceland

Disclosures:

A. Bjarnason, None

J. F. Gudnason, None

H. Asgeirsson, None

K. L. Hallgrimsson, None

B. Kristjansdottir, None

G. Haraldsson, None

O. Baldursson, None

K. G. Kristinsson, None

M. Gottfredsson, None

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