Health-care associated pneumonia

In recent years, a pneumonia which has been developed in people who have history of, hospitalization, accomodation in social-care facility, infusion therapy taken outpatiently, management of decubitus in house and receiving treatment in hemodialysis centers as a consequence of reforms in health system has being defined as a health-care associated pneumonia.Hence, we retrospectively assessed patients who has been hospitalized in Chest Disease Clinic of Akdeniz University Hospital due to health-care associated pneumonia (HCAP) and community acquaried pneumonia (CAP) between 1 January 2009 and 1 June 2012. In this study we aimed to compare demographic data, responsible/causative organisms, mortality rates and cost and duration of hospitalization of these two groups (The purpose of this study was to compare following parameters of these two groups: demographic data, responsible/causative organisms, mortality rates, hospitalization duration and cost).Of the total 195 pneumonia cases, 76 (38.9%) was HCAP and 119 (61.1%) was CAP. Sixty-one of HCAP cases (80.3%) have history of hospitalization more than one time in last 90 days, 7 cases (9.2%) have history of taking treatment in hemodialysis center in last 30 days, 3 cases (3.9%) have history of decubitus management in house, one case (1.3%) has a history of long term accomodation in social-care center and 1 case (1.3%) has a history of infusion therapy in house. Comorbidity was greater in HCAP group than CAP group (94.6% - 73.1%; p<0.001) and mean PSI scores were also higher in HCAP group (104.4 - 90.2; p<0.05). A causative microorganism was detected for 18 HCAP (23.6%) and 11 (9.2%) CAP cases. The predominantly isolated microorganism were S.pneumonia, A. baumannii, S.aureus (MRSA) in HCAP group and S.pneumonia, Klebsiella species, Pseudomonas aeruginosa, Moraxella catarrhalis in CAP group. It was determined that appropriate treatment was started in 73.7% of HCAP cases and 98.3% of CAP cases according to national and international guidelines (p< 0.001). Both mean hospitalization duration (12.7±1.1 vs 7.8±0.5 days, respectively; p<0.05) and mortality rate (22.4% vs 4.2%; p< 0.001) were higher in HCAP group. Furthermore, mean cost of hospitalization was also greater for HCAP group than CAP group (4150,6±892 TL vs 2078,7±571TL; p<0.05).As a conclusion; patient characteristics, comorbidity status, causative organisms, duration and cost of hospitalization and prognosis of patients with health-care associated pneumonia was different from patints with community acquired pneumonia. Thus, patients diagnosed with pneumonia should be comprehensively inquired in terms of health-care associated pneumonia and broad-spectrum antibiotics, especially covering resistent microorganisms, should be preferred/considered as an initial ampiric antibiotherapy.