218. Does Healthcare-Associated Pneumonia Convey a Higher Risk for Multi-Drug Resistant Organisms than Community-Acquired Pneumonia? A Propensity Score Case-Cohort Study
Session: Poster Abstract Session: Criticare, HAIs: Pneumonia and Chlorhexidine
Thursday, October 3, 2013
Room: The Moscone Center: Poster Hall C
  • Gross HCAP and MDRO (1024x512).jpg (413.8 kB)
  • Background:

    The healthcare-associated pneumonia (HCAP) classification introduced in the 2005 IDSA/ATS guidelines is controversial given its association with multi-drug resistant (MDR) organisms remains inconclusive. Aim: compare HCAP and community-acquired pneumonia (CAP) regarding the risk for MDR.


    Retrospective evaluation of adults admitted to a 624-bed U.S. academic medical center with an ICD-9 diagnosis code of pneumonia from Jan. 2010 to Dec. 2011. Patients must have had a new or progressive infiltrate on chest imaging and at least two of: hypo/hyperthermia, WBC <4k or >12k, or respiratory symptoms (e.g. cough, shortness of breath). HCAP and CAP were defined per IDSA/ATS guidelines. Chi-square, Mann-Whitney U, propensity scores and logistic regression were used for the analysis.


    519 patients included: 256 with HCAP and 263 with CAP. Baseline characteristics for the HCAP/CAP groups were the following: Age: 68.2yo/60.7yo (p<0.001); CURB65 score >1: 54.7%/28.5% (p<0.0001); WBC: 13.6K/13.2K (p=0.21); ICU admission: 8.6%/6.8% (p=0.45); immunocompromised status: 7.4%/1.1%% (p=0.28); MRSA colonization: 9%/3.8% (p=0.02); Pseudomonas colonization: 7.4%/1.1% (p<0.0001); stroke history: 18.8%/7.6% (p<0.0001); COPD: 33.2%/21.7% (p=0.003); heart failure: 24.2%/8.4% (p<0.0001); diabetes 29.3%/27.4% (p=0.63); antibiotic use in the last 90 days: 44.9%/19.1% (p<0.0001); number of hospitalized days in the last 180 days: 9.5/1.0 (p<0.0001). MDR organisms were identified in 5.9% and 1.9% of HCAP and CAP, respectively and the univariate analysis showed an OR=3.21 [95%CI 1.15-8.97]; p=0.026; however, the propensity score multivariable analysis with adjustments for age, CURB65 score, and baseline imbalances showed no association with MDR: OR=0.98 [95%CI 0.28-3.37]; p=0.97.


    The diagnosis of HCAP did not convey a higher risk for multi-drug resistant organisms compared to CAP when adjusting for age, severity of pneumonia, and baseline imbalances.

    Alan E. Gross, PharmD, BCPS1,2,3, Trevor C. Van Schooneveld, MD2,4, Mark E. Rupp, MD, FIDSA, FSHEA2,4, Keith M. Olsen, PharmD, FCCP, FCCM1,3, Thu Hong Bui1, Elsie Forsung1 and Andre C. Kalil, MD, MPH2, (1)College of Pharmacy, Univ. of Nebraska Med. Ctr., Omaha, NE, (2)Internal Med., Univ. of Nebraska Med. Ctr., Omaha, NE, (3)Pharmacy and Nutrition Services, The Nebraska Med. Ctr., Omaha, NE, (4)Infection Control & Epidemiology, The Nebraska Med. Ctr., Omaha, NE


    A. E. Gross, None

    T. C. Van Schooneveld, None

    M. E. Rupp, None

    K. M. Olsen, None

    T. H. Bui, None

    E. Forsung, None

    A. C. Kalil, None

    Findings in the abstracts are embargoed until 12:01 a.m. PST, Oct. 2nd with the exception of research findings presented at the IDWeek press conferences.