AIM: Nursing and healthcare-associated pneumonia (NHCAP) is a modified category of healthcare-associated pneumonia adjusted for the healthcare system of Japan. The clinical characteristics and risk factors for mortality have not been well characterized in elderly patients with NHCAP. METHODS: We retrospectively investigated 960 consecutive patients aged ≥65 years admitted for pneumonia. Baseline characteristics, severity, pathogen distribution, outcomes and risk factors for mortality were compared between patients with community-acquired pneumonia (CAP) and those with NHCAP. The applicability of age, dehydration, respiratory failure, orientation disturbance, and low BP (A-DROP) score, a standard severity index for CAP in Japan, was also evaluated in NHCAP. RESULTS: The study participants consisted of 373 patients (38.8%) with CAP and 587 (61.2%) with NHCAP. The patients with NHCAP were older and had poorer performance status (PS) and more comorbidities than those with CAP. The frequency of potentially drug-resistant (PDR) pathogens and in-hospital mortality were found in 10 (2.7%) and 17 patients (4.6%) with CAP, and 60 (10.2%) and 83 patients (14.1%) with NHCAP, respectively (P < 0.0001). The incidences of PDR pathogens and mortality were not significantly different among the criteria for NHCAP. The higher mortality was associated with PS, comorbidity with Charlson Comorbidity Index ≥3, and the coexistence of congestive heart failure, chronic kidney disease and malignancy. A-DROP score was poor at predicting mortality in most patients with NHCAP. CONCLUSION: The current criteria for NHCAP seem to be appropriate for differentiating patients with poor outcomes from community-acquired pneumonia patients. It is essential to assess individual underlying conditions, such as PS and comorbidity, when caring for patients with NHCAP.
AIM: Nursing and healthcare-associated pneumonia (NHCAP) is a modified category of healthcare-associated pneumonia adjusted for the healthcare system of Japan. The clinical characteristics and risk factors for mortality have not been well characterized in elderly patients with NHCAP. METHODS: We retrospectively investigated 960 consecutive patients aged ≥65 years admitted for pneumonia. Baseline characteristics, severity, pathogen distribution, outcomes and risk factors for mortality were compared between patients with community-acquired pneumonia (CAP) and those with NHCAP. The applicability of age, dehydration, respiratory failure, orientation disturbance, and low BP (A-DROP) score, a standard severity index for CAP in Japan, was also evaluated in NHCAP. RESULTS: The study participants consisted of 373 patients (38.8%) with CAP and 587 (61.2%) with NHCAP. The patients with NHCAP were older and had poorer performance status (PS) and more comorbidities than those with CAP. The frequency of potentially drug-resistant (PDR) pathogens and in-hospital mortality were found in 10 (2.7%) and 17 patients (4.6%) with CAP, and 60 (10.2%) and 83 patients (14.1%) with NHCAP, respectively (P < 0.0001). The incidences of PDR pathogens and mortality were not significantly different among the criteria for NHCAP. The higher mortality was associated with PS, comorbidity with Charlson Comorbidity Index ≥3, and the coexistence of congestive heart failure, chronic kidney disease and malignancy. A-DROP score was poor at predicting mortality in most patients with NHCAP. CONCLUSION: The current criteria for NHCAP seem to be appropriate for differentiating patients with poor outcomes from community-acquired pneumoniapatients. It is essential to assess individual underlying conditions, such as PS and comorbidity, when caring for patients with NHCAP.
Authors: Vanessa R Y Hollaar; Gert-Jan van der Putten; Claar D van der Maarel-Wierink; Ewald M Bronkhorst; Bert J M de Swart; Nico H J Creugers Journal: BMC Geriatr Date: 2017-06-19 Impact factor: 3.921