Healthcare associated pneumonia (HCAP) is a serious illness with mortality rates cited at 20% despite improved supportive care, and antimicrobial therapy. It is important to identify patients at highest risk of mortality to better determine management. The purpose of our study was to investigate in a large multicenter cohort over a several year period, the association of specific risk factors with inpatient mortality in HCAP patients.
This is a retrospective multicenter analysis of patients with pneumonia over an 11-year period from 4 large health care institutions. Participating centers included Henry Ford Health System, University of Maryland Medical System, Baylor Health Care System and Barnes Jewish Hospital. Patients were identified by diagnostic codes for pneumonia. Specifically, HCAP patients were identified as those who received an antipseudomonal beta-lactam or linezolid in the first 24 hours of hospitalization. A computer stores generated database was used to obtain demographic data including age, sex, cultured organism, Charlson comorbidity index, length of stay (LOS) and therapy.
There were 16,350 patients classified as HCAP. 2,712 (16.6%) expired from any cause during this hospitalization. Those expired were found to have significantly longer hospital LOS (18 vs 16 days, p <0.001), higher Charlson co-morbidity index (4.4 vs 3.8, p<0.001), older age (over 63 years p<0.001), and ventilator association (p-0.03). Organisms associated with higher mortality included E. coli and Aspergillus (p<0.001). HCAP patients without sputum obtained and organism identification had lower mortality (p<0.001). There was no significant mortality difference in those with MRSA, Pseudomonas, Klebsiella sp., and all other organisms
The results of our multicenter study suggest that HCAP patients with more comorbid conditions have increased risk of mortality. Organism identification was helpful in patient management and identifying patients at higher risk of mortality. However, those without organisms identified had lower mortality suggesting appropriate coverage by current HCAP regimens. There was no difference in outcomes in patients with MRSA, Pseudomonas, and Klebsiella sp. suggesting proper management of resistant organisms.
R. Sengupta, pfizer: Investigator , Research support
D. Moreno, pfizer: Investigator , Research support
A. D. Harris, pfizer: Investigator , Research support
S. J. Lawrence, Merck: Consultant , Consulting fee
pfizer: Investigator , Research support
A. Masica, pfizer: Investigator , Research support
L. Lamerato, pfizer: Investigator , Research support
M. Zervos, Pfizer: Principle investigator , Research grant to Henry Ford Hospital
Cerexa: Principle investigator , Research grant to Henry Ford Hospital
Tetraphase: Principle investigator , Research grant to Henry Ford Hospital