Healthcare-associated pneumonia among hospitalized patients. Is it really different from community acquired pneumonia?

Background . Current practice guideline suggested that all patients with health-care associated pneumonia (HCAP) should receive similar combination empirical therapy like hospital acquired pneumonia. This study aimed to determine the differences in etiology and clinical outcomes between HCAP and community acquired pneumonia (CAP) patients. Methods. We conducted a retrospective study of patients with HCAP and CAP who were hospitalized between January 2010 and December 2011. We investigated the 30-days mortality and occurrence of potentially drug-resistant (PDR) pathogens. Results. A total of 483 patients (208 HCAP patients, 275 CAP patients) were evaluated. HCAP patients were older than patients with CAP (mean 72.3 yr [SD 13.7] vs. 63.4 yr [SD 17.8]; p < 0.0001) and more frequently infected PDR pathogens (18.8% vs. 4.9%; p < 0.0001). Patients with HCAP had higher initial severity compared to CAP patients (Pneumonia Severity Index score, mean 122.8 [SD 35.1] vs. mean 85.8 [SD 41.6]; p < 0.0001) and mortality rate was increased in HCAP patients on univariate analysis. (16.3% vs. 5.1%; p < 0.0001). Multivariate logistic regression analysis after adjusting for sex, age, and inital severity, revealed that HCAP, use of antipseudomonal combination antibiotics, and occurrence of PDR pathogens are no more independent risk factors for 30-day mortality. Conclusions. HCAP is common cause of hospital admission and is associated with a high mortality. This increased mortality was primarily related to age and initial severity rather than HCAP and presence of PDR pathogens. It may suggest that HCAP patients could be treated in the same way as patients with severe CAP.