Abstract
More than 70000 russians die of pneumonia every year. In 2005, ATS/IDSA published important guidelines for the management of healthcare-associated pneumonia (HCAP).
HCAP defines higher risk of antibiotic-resistant pathogens. In Russia, however, the optimum strategy for management of HCAP is still unclear.
The purpose of this study was to clarify the clinical features of patients with HCAP compared with a community-acquired pneumonia (CAP).
Materials and methods: Patients (n = 2115; 1289 males, mean age 65.9 ± 15.1 years) who were consecutively admitted with a diagnosis of pneumonia. CAP group (n = 1673), and HCAP group (n = 442). Among HCAP patients, 240 (54.4%) had a history of hospitalization in the last 90 days, 131 (29.6%) received outpatient intravenous therapy, 60 (13.6%) had home wound care and 11 (2.5%) lived in a nursing home.
Compared with patients with CAP, patients with HCAP were older (mean age, 70.6 vs 63.9 years), had greater comorbidity (97.5% vs 72.1%) high-risk pneumonia severity index classes (66.8% vs 43.6%; al P < .001).
The causative pathogen was detected in 164 (37.1%) HCAP and 185 (11.1%) CAP.
MDR pathogens were more common (17.1% vs 2.2%) in HCAP p-ts than in CAP p-ts, including Staphylococcus aureus (14.0% vs 1.1%).
The duration of hospitalization (15.7 ± 10.1 vs. 11.3 ± 6.5 days) and mortality rate (11.3% vs. 3.0%; al P< 0.001) were higher in HCAP compared with CAP patients.
Conclusion: HCAP is common in Russia and is characterized by inappropriate initial empiric therapy and high mortality. At a part of patients high mortality was associated primarily with the general state, at another part - with drug-resistant microorganisms, that needs further study.
- Copyright ©ERS 2015