Mario Venditti, MD; Marco Falcone, MD; Salvatore Corrao, MD; Giuseppe Licata, MD; Pietro Serra, MD; the Study Group of the Italian Society of Internal Medicine
Acknowledgment: The authors thank Professor Pier Mannuccio Mannucci, Milan, Italy, for his activity as Chief of the Italian Society of Internal Medicine group for independent clinical research. They also thank Sohita Dhillon and Rod McNab of Wolters Kluwer Health for English-language assistance in the preparation of this manuscript.
Potential Financial Conflicts of Interest:Consultancies: M. Venditti (Glaxo Wellcome, Gilead, Angelini, Novartis, Pfizer, Bayer, Wyeth). Grants received: M. Falcone (Pfizer).
Reproducible Research Statement:Study protocol: Available at http://www.simi.it. Statistical code: Available from Dr. Corrao (firstname.lastname@example.org). Data set: Not available.
Requests for Single Reprints: Mario Venditti, MD, Dipartimento di Medicina Clinica—Policlinico Umberto I, Università di Roma “La Sapienza,” Viale dell'Università 37, 00161 Rome, Italy; e-mail, email@example.com.
Current Author Addresses: Drs. Venditti, Falcone, and Serra: Dipartimento di Medicina Clinica—Policlinico Umberto I, Università di Roma “La Sapienza,” Viale dell'Università 37, 00161 Rome, Italy.
Drs. Corrao and Licata: Dipartimento Biomedico di Medicina Interna e Specialistica, Università degli Studi di Palermo, Piazza delle Cliniche 2, 90127 Palermo, Italy.
Author Contributions: Conception and design: M. Venditti, M. Falcone, P. Serra.
Analysis and interpretation of the data: M. Venditti, M. Falcone, S. Corrao.
Drafting of the article: M. Venditti, M. Falcone.
Critical revision of the article for important intellectual content: S. Corrao, G. Licata, P. Serra.
Final approval of the article: S. Corrao, G. Licata, P. Serra.
Provision of study materials or patients: G. Licata.
Statistical expertise: S. Corrao.
Obtaining of funding: G. Licata.
Administrative, technical, or logistic support: G. Licata.
Collection and assembly of data: M. Falcone, S. Corrao.
For a complete list of study group members, see the Appendix.
Venditti M, Falcone M, Corrao S, Licata G, Serra P, the Study Group of the Italian Society of Internal Medicine. Outcomes of Patients Hospitalized With Community-Acquired, Health Care–Associated, and Hospital-Acquired Pneumonia. Ann Intern Med. 2009;150:19-26. doi: 10.7326/0003-4819-150-1-200901060-00005
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Published: Ann Intern Med. 2009;150(1):19-26.
Traditionally, pneumonia has been classified as either community- or hospital-acquired. Although only limited data are available, health careâ€“associated pneumonia has been recently proposed as a new category of respiratory infection. â€œHealth careâ€“associated pneumoniaâ€ refers to pneumonia in patients who have recently been hospitalized, had hemodialysis, or received intravenous chemotherapy or reside in a nursing home or long-term care facility.
To ascertain the epidemiology and outcome of community-acquired, health careâ€“associated, and hospital-acquired pneumonia in adults hospitalized in internal medicine wards.
Multicenter, prospective observational study.
55 hospitals in Italy comprising 1941 beds.
362 patients hospitalized with pneumonia during two 1-week surveillance periods.
Cases of radiologically and clinically assessed pneumonia were classified as community-acquired, health careâ€“associated, or hospital-acquired and rates were compared.
Of the 362 patients, 61.6% had community-acquired pneumonia, 24.9% had health careâ€“associated pneumonia, and 13.5% had hospital-acquired pneumonia. Patients with health careâ€“associated pneumonia had higher mean Sequential Organ Failure Assessment scores than did those with community-acquired pneumonia (3.0 vs. 2.0), were more frequently malnourished (11.1% vs. 4.5%, and had more frequent bilateral (34.4% vs. 19.7%) and multilobar (27.8% vs. 21.5%) involvement on a chest radiograph. Patients with health careâ€“associated pneumonia also had higher fatality rates (17.8% [CI, 10.6% to 24.9%] vs. 6.7% [CI, 2.9% to 10.5%]) and longer mean hospital stay (18.7 days [CI, 15.9 to 21.5 days] vs. 14.7 days [CI, 13.4 to 15.9 days]). Logistic regression analysis revealed that depression of consciousness (odds ratio [OR], 3.2 [CI, 1.06 to 9.8]), leukopenia (OR, 6.2 [CI, 1.01 to 37.6]), and receipt of empirical antibiotic therapy not recommended by international guidelines (OR, 6.4 [CI, 2.3 to 17.6]) were independently associated with increased intrahospital mortality.
The number of patients with health careâ€“associated pneumonia was relatively small. Microbiological investigations were not always homogeneous. The study included only patients with pneumonia that required hospitalization; results may not apply to patients treated as outpatients.
Health careâ€“associated pneumonia should be considered a distinct subset of pneumonia associated with more severe disease, longer hospital stay, and higher mortality rates. Physicians should differentiate between patients with health careâ€“associated pneumonia and those with community-acquired pneumonia and provide more appropriate initial antibiotic therapy.
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Hospital Medicine, Infectious Disease, Pulmonary/Critical Care, Pneumonia, Hospital-Acquired Infections.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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