Declined Functional Status Prolonged Hospital Stay for Community-Acquired Pneumonia in Seniors

Figures & data

Table 1 Population Demographics and Characteristics of Patients with Early and Delayed Discharge

Demographic/Characteristics	Total	Early Discharge	Delayed Discharge	p-value
	n=325	n=170	n=155
Age (years)	80 (74–85)	78 (72–84)	82 (77–86)	0.01
Sex (male/female)	212/113	111/59	101/54	0.98
BMI (kg/m^2)	19.6 (16–22)	20.0 (17–23)	19.2 (16–22)	0.07
Dementia	41 (12.6%)	15 (21.4)	26 (26.2)	0.03
Bedsores	6 (1.85%)	4 (2.5%)	2 (1.6%)	0.48
Aspiration	38 (11.7%)	9 (11.4%)	29 (25.1%)	<0.01
CCI				0.21
≤1	135 (41.5%)	74 (43.5%)	61 (39.4%)
2	90 (27.7%)	40 (23.5%)	50 (32.3%)
≥3	100 (30.8%)	56 (32.9%)	44 (28.4%)
PSI category				<0.01
II	38 (11.7%)	31 (18.2%)	7 (4.5%)
III	107 (32.9%)	63 (37.1%)	44 (28.4%)
IV	143 (44%)	64 (37.6%)	79 (51.0%)
V	37 (11.4%)	12 (7.1%)	25 (16.1%)
Initial prescription				0.83
Ceftriaxone	138 (42.5%)	68 (40.0%)	70 (45.2%)
SBT/ABPC	85 (26.2%)	49 (28.8%)	36 (23.2%)
TAZ/PIPC	62 (19.1%)	34 (20.0%)	28 (18.1%)
Cefepime	20 (6.2%)	10 (5.9%)	10 (6.5%)
Levofloxacin	9 (2.8%)	4 (2.9%)	5 (3.2%)
Others	11 (3.4%)	5 (2.4%)	6 (3.9%)

Abbreviations: BMI, body mass index; CCI, Charlson Comorbidity Index; PSI, pneumonia severity index; SBT/ABPC, sulbactam/ampicillin; TAZ/PIPC, tazobactam/piperacillin.

Figure 1 Flowchart for the study.

Abbreviations: HCAP, healthcare-associated pneumonia; HAP, hospital-acquired pneumonia; CAP, community-acquired pneumonia.

Table 2 Distribution of Causative Microorganisms in Sputum Cultures from Patients with Early and Delayed Discharge*

Microorganisms	Total	Early Discharge	Delayed Discharge
	n=325	n=170	n=155
Streptococcus pneumoniae	36 (11.1%)	24 (14.1%)	12 (7.7%)
Klebsiella pneumoniae	25 (7.7%)	11 (6.5%)	14 (9.0%)
Klebsiella oxytoca	5 (1.5%)	2 (1.2%)	3 (3.2%)
Escherichia coli	12 (3.7%)	7 (4.1%)	5 (3.2%)
Enterobacter aerogenes	3 (0.9%)	2 (1.2%)	1 (0.7%)
Enterobacter cloacae	3 (0.9%)	2 (1.2%)	1 (0.7%)
Pseudomonas aerogenes	16 (4.9%)	8 (4.7%)	8 (5.2%)
Pseudomonas fluorescens	2 (0.6%)	1 (0.6%)	1 (0.7%)
Haemophilus influenzae	12 (3.7%)	6 (3.5%)	6 (3.9%)
Moraxella branhamel	8 (2.5%)	2 (1.2%)	6 (3.9%)
Staphylococcus aureus	22 (6.8%)	7 (4.1%)	15 (9.7%)
Streptococcus agalactiae	2 (0.6%)	1 (0.6%)	1 (0.7%)
Stenotrophomonas maltophilia	5 (1.5%)	1 (0.6%)	4 (2.6%)
Raoultella planticola	4 (1.2%)	3 (1.9%)	1 (0.7%)
Mixed	7 (2.2%)	3 (1.8%)	4 (2.6%)
Other causative microorganisms	4 (1.2%)	1 (0.6%)	3 (3.2%)
Normal flora	143 (44.0%)	78 (45.9%)	65 (41.9%)
Not tested or missing data	16 (4.9%)	11 (6.5%)	5 (3.2%)

Note: *p-value for distribution of causative microorganisms was 0.38 overall.

Table 3 Outcomes and Costs of Patients with Early and Delayed Discharge

Outcomes	Total	Early Discharge	Delayed Discharge	p-value
	(n=325)	(n=170)	(n=155)
ADL before admission				0.002
Independent	237 (72.9%)	137 (80.6%)	100 (64.5%)
Semi-dependent	70 (21.5%)	24 (14.1%)	46 (29.7%)
Dependent	18 (5.5%)	9 (5.3%)	9 (5.8%)
ADL after admission				<0.001
Independent	198 (64.3%)	131 (82.4%)	67 (45.0%)
Semi-dependent	76 (24.7%)	22 (13.8%)	54 (36.2%)
Dependent	34 (11.0%)	6 (37.7%)	28 (18.8%)
Enrolled for rehabilitation	195 (60%)	77 (45.3%)	118 (76.1%)	<0.001
Decreased FS	65 (20%)	16 (9.4%)	49 (31.6%)	<0.001
LOAT (days)	8 (7–12)	8 (6–10)	10 (7–15)	<0.001
Length of stay (days)	16 (10–27)	10 (7–13)	29 (21–44)	<0.001
Discharge in 2 weeks	144 (44.3%)	141 (82.9%)	3 (1.9%)	<0.001
Discharge in 4 weeks	246 (75.7%)	169 (99.4%)	77 (49.7%)	<0.001
Survival outcome				<0.001
At home	198 (60.9%)	131 (77.1%)	67 (43.2%)
Nursing home	74 (22.8%)	24 (14.1%)	50 (32.3%)
Facility	19 (5.8%)	2 (1.2%)	17 (11.0%)
Hospital	17 (5.2%)	2 (1.2%)	15 (9.7%)
In-hospital mortality	17 (5.2%)	11 (6.5%)	6 (3.9%)	0.291
Cost ($)	5457 (3817–8270)	3817 (2954–4680)	8631 (6680–12,551)	<0.001

Abbreviations: ADL, activities of daily living; FS, functional status; LOAT, length of antibacterial treatment.

Table 4 Multivariate Analysis of Factors Contributing to Delayed Discharge and In-Hospital Mortality

Risk Factors	Delayed Discharge				In-Hospital Mortality
	OR	95% CI		p value	OR	95% CI		p value
Decreased FS	4.31	2.32	7.98	<0.01	21.6	5.1	119.1	<0.01
Enrolled for rehabilitation	2.34	1.43	3.82	<0.01
PSI				<0.01	18.3	3.8	93.2	<0.01*
III vs II	3.63	1.37	9.69
IV vs II	5.08	1.81	14.3
V vs II	15.96	4.56	55.8
Aspiration	2.48	1.11	5.98		4.61	1.35	16.22	0.02
Age	1.03	1.01	1.06	0.02	1.04	1.01	1.09	0.04

Note: *Odds ratio for PSI of category V.

Abbreviations: OR, odds ratio; CI, confidence interval; FS, functional status; PSI, pneumonia severity index.