Please use this identifier to cite or link to this item: http://hdl.handle.net/10553/123986
Title: Microbial aetiology of healthcare associated pneumonia in Spain: A prospective, multicentre, case-control study
Authors: Polverino, Eva
Torres, Antoni
Menendez, Rosario
Cillóniz, Catia
Valles, Jose Manuel
Capelastegui, Alberto
Marcos, M. Angeles
Alfageme, Inmaculada
Zalacain, Rafael
Almirall, Jordi
Molinos, Luis
Bello, Salvador
Rodríguez De Castro, Felipe Carlos B. 
Blanquer, Josep
Dorado, Antonio
Llevat, Noelia
Rello, Jordi
UNESCO Clasification: 32 Ciencias médicas
3212 Salud pública
320103 Microbiología clínica
3202 Epidemologia
Keywords: Anti-Bacterial agents
Community-Acquired infections
Pneumonia
Issue Date: 2013
Journal: Thorax 
Abstract: Introduction Healthcare-associated pneumonia (HCAP) is actually considered a subgroup of hospital-acquired pneumonia due to the reported high risk of multidrug-resistant pathogens in the USA. Therefore, current American Thoracic Society/ Infectious Diseases Society of America guidelines suggest a nosocomial antibiotic treatment for HCAP. Unfortunately, the scientific evidence supporting this is contradictory. Methods We conducted a prospective multicentre case-control study in Spain, comparing clinical presentation, outcomes and microbial aetiology of HCAP and community-acquired pneumonia (CAP) patients matched by age (±10 years), gender and period of admission (±10 weeks). Results 476 patients (238 cases, 238 controls) were recruited for 2 years from June 2008. HCAP cases showed significantly more comorbidities (including dysphagia), higher frequency of previous antibiotic use in the preceding month, higher pneumonia severity score and worse clinical status (Charslon and Barthel scores). While microbial aetiology did not differ between the two groups (HCAP and CAP: Streptococcus pneumoniae: 51% vs 55%; viruses: 22% vs 12%; Legionella: 4% vs 9%; Gram-negative bacilli: 5% vs 4%; Pseudomonas aeruginosa: 4% vs 1%), HCAP patients showed worse mortality rates (1-month: HCAP, 12%; CAP 5%; 1-year: HCAP, 24%; CAP, 9%), length of hospital stay (9 vs 7 days), 1-month treatment failure (5.5% vs 1.5%) and readmission rate (18% vs 11%) (p<0.05, each). Conclusions Despite a similar clinical presentation, HCAP was more severe due to patients' conditions (comorbidities) and showed worse clinical outcomes. Microbial aetiology of HCAP did not differ from CAP indicating that it is not related to increased mortality and in Spain most HCAP patients do not need nosocomial antibiotic coverage.
URI: http://hdl.handle.net/10553/123986
ISSN: 0040-6376
DOI: 10.1136/thoraxjnl-2013-203828
Source: Thorax [ISSN 0040-6376], v. 68 (11), p. 1007-1014 (Noviembre 2013)
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