A retrospective study of non-ventilator hospital-acquired pneumonia in a Norwegian hospital: a serious medical condition in need of better and timelier microbiological diagnostics

Figures & data

Figure 1. Flowchart of the inclusion process and selection of patients and episodes.

Table 1. Baseline demographics, clinical and biochemical features at time of inclusion.

Patient characteristics					N
Age, years	74.0 (67.0–81.0)				119
Male sex, No. (%)	75 (63.0)				119
Charlson comorbidity index score	5.0 (4–7)				119
Coronary artery disease, No. (%)	50 (42.0)				119
Diabetes, No. (%)	27 (22.7)				119
Pulmonarydisease, No. (%)	36 (30.3)				119
Immunosuppression, No. (%)	17 (14.3)
	Active	Previous			119
Smokers, No. (%)	20 (16.8)	53 (44.5)			119
Admission data
Emergency admission, No. (%)	88 (73.9)				119
	Regular	ICU^a
Ward at time of diagnosis, No. (%)	102 (85.7)	17 (14.3)			119
	Medical	Surgical	Orthopedic	Neurology
Department at time of diagnosis, No. (%)	61 (51.3)	38 (31.9)	9 (7.6)	11 (9.2)	119
Clinical and biochemical features
NEWS2^b score	8.0 (5.0–10.0)				105
SOFA^c score	4.0 (2.0–6.8)				24
CRP^d, mg/L	139.0 (83.5–219.0)				117
Leukocytes, * 10^9/L	13.2 (10.0–15.8)				119

Data are presented as median (IQR lower − IQR upper) or number (percent). For NEWS2 and SOFA N was 105 and 24 respectively due to missing data.

^a ICU = intensive care unit.

^b NEWS2 = National Early Warning System 2.

^c SOFA = Sequential organ failure assessment.

^d CRP = C-reactive protein.

Table 2. Clinical outcomes.

		N
Hospital LOS^a, days (range)	17.2 (12–24.3)	119
ICU admission, No. (%)	51 (42.9)	119
ICU LOS^b, days (range)	3.25 (1.9–8.9)	51
Mechanical ventilation, No. (%)	13 (10.9)	119
Mechanical ventilation^c, days (range)	6 (2.5–11.5)	13
In-hospital mortality, No. (%)	25 (21.0)	119
30-Day mortality accumulated, No. (%)	33 (27.7)	119
1-Year mortality accumulated, No. (%)	47 (39.5)	119
30-Day readmission, No. (%)	37 (39.4)	94

Values expressed as median (IQR lower − IQR upper) or No. (percent).

^aLOS = Length of stay.

^bAmong patients requiring ICU-admission.

^cAmong patients requiring mechanical ventilation.

Table 3. Microbiological sampling and findings.

Sample type, No. (%)	Samples collected	Samples with a positive finding	N
Nasopharyngeal swab PCR	29 (24.4)	4 (13.8)	119
Sputum	6 (5.0)	5 (83.3)	119
Induced sputum	1 (0.8)	1 (100)	119
BAL/mini-BAL	7 (5.9)	7 (100)	119
Blood cultures	64 (53.8)	4 (6.3)	119
Pneumococcus urine antigen test	6 (5.0)	0 (0)	119
Legionella urine antigen test	7 (5.9)	0 (0)	119
BAL/mini-BAL	Clinical relevance
Candida albicans	Yes
Candida albicans	No
Haemophilus influenzae & Streptococcus pneumoniae	Yes
Candida albicans	Yes
Streptococcus anginosus	Uncertain
Staphylococcus aureus	Yes
Proteus mirabilis	Uncertain
Induced sputum
Legionella species (PCR)	Yes
Sputum
Legionella species (PCR)	Yes
Streptococcus pneumoniae	Yes
Candida albicans	No
Moraxella catarrhalis	Yes
Normal throat flora
Streptococcus pneumoniae	Yes
Blood cultures
Candida albicans	Yes
Pseudomonas aeruginosa	Yes
Escherichia coli	Yes
Candida albicans	Yes
PCR^b conducted on nasopharyngeal swabs
Influenza A virus	Yes
Influenza A virus	Yes
Influenza B virus	Yes
Human parainfluenza virus 3 & Rhinovirus	Yes

All findings in BAL/mini-BAL and sputum are from cultures with subsequent Matrix-assisted laser desorption/ionization time-of-flight mass spectrometer (MALDI-TOF) unless otherwise specified.

Clinical relevance was determined by treating clinicians opinion as documented in patient charts.

^a BAL = Bronchoalveolear lavage.

^b PCR = Polymerase chain reaction.

Data availability statement

The datasets generated and analysed during the current study are not publicly available but are available from the corresponding author on reasonable request.