Methods: We conducted a single center retrospective cohort study (2008-2013) in adult patients with HOMP. We defined pneumonia based on clinical criteria and all cases were culture confirmed. MRSA bacteremia was identified based on blood cultures. Pneumonia was categorized as HOMP if it occurred >2 days after admission. We compared bacteremic and non-bacteremic groups with respect to demographic and clinical characteristics and outcomes. A generalized linear model (GLM) was constructed to examine the impact of bacteremia on post-pneumonia onset LOS.
Results: Among the 513 patients with HOMP, 58 (11.3%) had concurrent bacteremia. Patients with bacteremia were similar to non-bacteremic subjects based on demographic and clinical characteristics with the exception of the prevalence of chronic liver disease (17.2% bacteremic vs. 8.6% non-bacteremic, p=0.034). There was a trend towards more frequent recent hospitalization (prior 180 days) among bacteremic subjects (43.1% vs. 33.2%, p=0.134). The mean APACHE II scores at the onset of pneumonia did not differ between groups (16.2+/- 5.8 vs. 16.5+/- 5.7, p=0.506). The unadjusted mortality was numerically higher among those with bacteremia than those without (35.1% vs. 26.2%, p=0.220). Median post-pneumonia LOS (22.8 vs. 13.2 days, p<0.001) was greater in the bacteremic group. In a GLM controlling for multiple covariates including appropriateness of initial therapy, concomitant bacteremia was independently associated with a 13.5-day increase in the post-pneumonia hospital LOS (95% confidence interval 8.4 to 18.5 days).
Conclusion: Concurrent bacteremia occurred with moderate frequency in the setting of MRSA HOMP. Bacteremia complicating MRSA HOMP added nearly two weeks to the hospital LOS.
A. F. Shorr,
Cubist: Consultant and Investigator , Research grant
Pfizer: Consultant and Investigator , Research grant
Tetraphase: Consultant and Investigator , Research support
Medco: Consultant and Investigator , Research grant
Cubist: Consultant and Investigator , Research support
Tetraphase: Investigator , Research support
Medco: Investigator , Research grant
S. Micek, Theravance: Consultant and Investigator , Research support
M. H. Kollef, Theravance: Consultant and Investigator , Research grant