Mortality in healthcare-associated pneumonia in a low resistance setting: a prospective observational study

Figures & data

Table I. Occurrence of classification factors for CAP or HCAP.^a

Risk factor	CAP (n = 236)	HCAP (n = 137)
Long-term nursing care	0 (0)	30 (22)
Admission to acute care facility within 14–90 days	0 (0)	61 (45)
Malignancy	8 (3)^b	18 (13)
Corticosteroid treatment	5 (2)^c	59 (43)
Hemodialysis	0 (0)	2 (1)

CAP, community-acquired pneumonia; HCAP, healthcare- associated pneumonia.

^aData presented as n (%). As individual patients can have multiple risk factors, percentages can exceed 100%.

^bPatients with malignancy but not receiving active treatment.

^cCorticosteroid on admission at doses equivalent to < 5 mg.

Table II. Comparison of characteristics and outcomes.^a

Variable	CAP (n = 236)	HCAP (n = 137)	p value
Age (years), mean (95% CI)	59.9 (57.2–62.5)	70.0 (67.2–72.7)	< 0.001
Male	111 (47)	69 (50)	NS
Underlying disease^b	121 (51)	101 (74)	< 0.001
Asthma	32 (14)	22 (16)	NS
COPD	51 (22)	49 (36)	0.003
Ischemic heart disease	38 (16)	39 (29)	0.004
Heart failure	20 (9)	28 (20)	0.001
Chronic renal failure	19 (8)	18 (13)	NS
Diabetes type I	3 (1)	0	NS
Diabetes type II	30 (13)	17 (12)	NS
Cerebrovascular disease	11 (5)	11 (8)	NS
Malignancy	8 (3)	18 (13)	< 0.001
Severity scores, mean (95% CI)
APACHE II score	8.64 (8.05–9.23)	12.62 (11.69–13.55)	< 0.001
PSI score	2.58 (2.43–2.74)	3.42 (3.23–3.60)	< 0.001
PSI value	71.40 (67.19–75.61)	94.86 (89.23–100.50)	< 0.001
CURB-65	1.46 (1.37–1.55)	1.79 (1.65–1.93)	< 0.001

APACHE, Acute Physiology and Chronic Health Evaluation; CAP, community-acquired pneumonia; CI, confidence interval; COPD, chronic obstructive pulmonary disease; CURB-65, confusion, urea, respiratory rate, blood pressure, age ≥ 65; HCAP, healthcare-associated pneumonia; NS, not significant; PSI, pneumonia severity index.

^aData presented as n () unless otherwise stated.

^bUnderlying disease includes patients with at least one of the following: COPD, asthma, diabetes mellitus type I or II, ischemic heart disease, heart failure, chronic renal failure, cerebrovascular disease or malignancy.

Table III. Distribution of diagnosed pathogens between patient groups.^a

Variables	CAP (n = 236)	HCAP (n = 137)	p value^b
Diagnosed cases	107 (45)	54 (39)	NS
Cases with two pathogens	10 (4)	6 (4)	NS
Etiologic agents
Streptococcus pneumoniae	30 (28)	22 (41)	NS
Haemophilus influenzae	15 (14)	5 (9)	NS
Moraxella catarrhalis	5 (5)	3 (6)	NS
Staphylococcus aureus	5 (5)	3 (6)	NS
β-Hemolytic streptococci	4 (4)	2 (4)	NS
Mycoplasma pneumoniae	30 (28)	6 (11)	0.009
Chlamydophila pneumoniae	3 (3)	2 (4)	NS
Legionella species	1 (1)	4 (7)	0.044
Gram-negative bacilli^c	2 (1)	6 (11)	0.020
Influenza A and B	22 (21)	3 (6)	0.012
Mycobacteria	0 (0)	2 (4)	NS
Pneumocystis jirovecii	0	1 (2)	NS
Parainfluenza 2	0 (0)	1 (2)	NS

CAP, community-acquired pneumonia; HCAP, healthcare- associated pneumonia.

^aData expressed as n ().

^bCalculations included only diagnosed cases.

^cAcinetobacter species, Burkholderia pseudomallei, Enterobacter cloacae, Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Stenotrophomonas maltophilia.

Table IV. Comparison of treatment and outcomes.^a

	CAP (n = 236)	HCAP (n = 137)	p value
Antimicrobial therapy
Penicillins^b	15 (6)	7 (5)	NS
Penicillin combinations^c	153 (65)	78 (57)	NS
Cephalosporins^d	25 (11)	26 (19)	0.023
Carbapenems^e	4 (2)	1 (1)	NS
Macrolides^f	24 (10)	10 (7)	NS
Quinolones^g	2 (1)	6 (4)	NS
Other antimicrobials^h	6 (3)	7 (5)	NS
Antivirals^i	7 (3)	2 (1)	NS
β-Lactam plus macrolide	103 (43.6)	43 (31.4)	0.019
Ineffective initial therapy	4 (2)	8 (6)	NS^j
Outcomes
Length of stay (days), mean 95% CI	7.39 (6.7–8.1)	8.2 (7.5–9.0)	NS
ICU admission	21 (9)	11 (8)	NS
Mechanical ventilation	7 (3)	5 (4)	NS
In-house mortality	3 (1)	14 (10)	< 0.001

CAP, community-acquired pneumonia; CI, confidence interval; HCAP, healthcare-associated pneumonia; ICU, intensive care unit.

^aData expressed as n (%) unless otherwise noted.

^bAmoxicillin, phenoxymethylpenicillin or cloxacillin.

^cAmoxicillin plus clavulanic acid.

^dCefazolin, cefuroxime, ceftriaxone or ceftazidime.

^eMeropenem.

^f Erythromycin, clarithromycin or azithromycin.

^gCiprofloxacin.

^hClindamycin, doxycyclin, vancomycin or trimethoprim sulfamethoxazole.

ⁱOseltamivir.

^jCases lacking adequate data for determination of therapy effectiveness were censured from the statistical comparison (n = 71).