Risk factors for hospital-acquired pneumonia outside the intensive care unit: A case-control study

doi:10.1016/j.ajic.2013.06.021

American Journal of Infection Control

Volume 42, Issue 1, January 2014, Pages 38-42

The results of this article were presented in part in the 48th Annual Interscience Conference on Antimicrobial Agents and Chemotherapy/46th Infectious Diseases Society of America Annual Meeting, Washington DC, October 25, 2008, and at the 49th Annual Interscience Conference on Antimicrobial Agents and Chemotherapy, San Francisco, September 12, 2009.

https://doi.org/10.1016/j.ajic.2013.06.021 Get rights and content

Background

Hospital-acquired pneumonia (HAP) is one of the leading nosocomial infections and is associated with high morbidity and mortality. Numerous studies on HAP have been performed in intensive care units (ICUs), whereas very few have focused on patients in general wards. This study examined the incidence of, risk factors for, and outcomes of HAP outside the ICU.

Methods

An incident case-control study was conducted in a 600-bed hospital between January 2006 and April 2008. Each case of HAP was randomly matched with 2 paired controls. Data on risk factors, patient characteristics, and outcomes were collected.

Results

The study group comprised 119 patients with HAP and 238 controls. The incidence of HAP outside the ICU was 2.45 cases per 1,000 discharges. Multivariate analysis identified malnutrition, chronic renal failure, anemia, depression of consciousness, Charlson comorbidity index ≥3, previous hospitalization, and thoracic surgery as significant risk factors for HAP. Complications occurred in 57.1% patients. The mortality attributed to HAP was 27.7%.

Conclusions

HAP outside the ICU prevailed in patients with malnutrition, chronic renal failure, anemia, depression of consciousness, comorbidity, recent hospitalization, and thoracic surgery. HAP in general wards carries an elevated morbidity and mortality and is associated with increased length of hospital stay and increased rate of discharge to a skilled nursing facility.

Section snippets

Study design, patients, and setting

This prospective study was performed at Germans Trias i Pujol University Hospital, a 600-bed tertiary hospital with 20,000 annual admissions, between January 2006 and April 2008. Adult patients (age ≥18 years) diagnosed with HAP and hospitalized in conventional medical, surgical, and trauma wards were prospectively identified through a passive and active surveillance system based on daily review of chest radiology reports. Patients with chest radiography demonstrating new infiltrates were

Incidence and place of acquisition of HAP

The study group comprised 119 cases with HAP and 238 controls. The incidence rate of HAP in the general hospitalization wards was 2.45 cases/1,000 hospital admissions (95% CI, 2.04-2.92). The wards in which the cases were detected and the incidence of HAP are shown in Table 1.

Risk factors for HAP

The HAP cases had a mean age of 70 ± 14.46 years, and 72.3% were males. Length of previous hospital stay was >5 days in 87 of the 105 cases (82.9%), with a mean of 17.69 ± 12.67 days. Fourteen patients (11.8%) were newly

Discussion

This study shows that patients with malnutrition, chronic renal failure, anemia, depressed consciousness, higher Charlson comorbidity index, previous thoracic surgery, and previous hospital admission are at greater risk for HAP outside the ICU, with an incidence of 2.45 cases/1,000 discharges. We also found that HAP has a high morbidity and mortality, with increased length of stay and increased rate of discharge to a skilled nursing facility.

The incidence of HAP was slightly lower than that

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: This study was supported by research grant FIS PI051492 from the Ministerio de Sanidad, Instituto de Salud Carlos III, Spain, 2005-2007.

: Conflict of interest: None to report.

: Author contributions: Study supervision: N.S., E.H., I.C., and M.S.; study conception and design: N.S. and M.S.; data collection: N.S., E.H., S.R., M.L.P.-B., J.B., and I.G.; analysis and interpretation of data, N.S., E.H., I.C., and M.S.; statistical analysis: N.S. and I.C.; drafting of the manuscript: N.S., E.H., and M.S.; critical revision of the manuscript: N.S., E.H., I.C., S.R., M.L.P.-B., J.B., I.G., and M.S.

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Major articleRisk factors for hospital-acquired pneumonia outside the intensive care unit: A case-control study

Background

Methods

Results

Conclusions

Section snippets

Study design, patients, and setting

Incidence and place of acquisition of HAP

Risk factors for HAP

Discussion

Chest

Chest

Am J Kidney Dis

Clin Microbiol Infect

Respir Med

Nosocomial pneumonia

American Thoracic Society, Infectious Diseases Society of America. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia

Am J Resp Crit Care Med

Nosocomial pneumonia in the intensive care unit acquired by mechanically ventilated versus nonventilated patients

Am J Respir Crit Care Med

Retrospective analysis of risk factors and prognosis in non-ventilated patients with nosocomial pneumonia

Eur J Clin Microbiol Infect Dis

Major article
Risk factors for hospital-acquired pneumonia outside the intensive care unit: A case-control study