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Baek MS, Baek AR, Hong SB, Bae S, Park HK, Kim C, Lee HK, Cho WH, Kim JH, Chang Y, Lee HB, Gil HI, Shin B, Yoo KH, Moon JY, Oh JY, Min KH, Jeon K. Empiric Anti-Pseudomonal β-Lactam Monotherapy Versus Fluoroquinolone Combination Therapy in Patients With Hospital-Acquired Pneumonia: A Multicenter Cohort Study With Propensity Score Matching. J Korean Med Sci 2023; 38:e353. [PMID: 37873633 PMCID: PMC10593602 DOI: 10.3346/jkms.2023.38.e353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 06/19/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND There is insufficient data on the benefits of empiric antibiotic combinations for hospital-acquired pneumonia (HAP). We aimed to investigate whether empiric anti-pseudomonal combination therapy with fluoroquinolones decreases mortality in patients with HAP. METHODS This multicenter, retrospective cohort study included adult patients admitted to 16 tertiary and general hospitals in Korea between January 1 and December 31, 2019. Patients with risk factors for combination therapy were divided into anti-pseudomonal non-carbapenem β-lactam monotherapy and fluoroquinolone combination therapy groups. Primary outcome was 30-day mortality. Propensity score matching (PSM) was used to reduce selection bias. RESULTS In total, 631 patients with HAP were enrolled. Monotherapy was prescribed in 54.7% (n = 345) of the patients, and combination therapy was prescribed in 45.3% (n = 286). There was no significant difference in 30-day mortality between the two groups (16.8% vs. 18.2%, P = 0.729) or even after the PSM (17.5% vs. 18.2%, P = 0.913). After the PSM, adjusted hazard ratio for 30-day mortality from the combination therapy was 1.646 (95% confidence interval, 0.782-3.461; P = 0.189) in the Cox proportional hazards model. Moreover, there was no significant difference in the appropriateness of initial empiric antibiotics between the two groups (55.0% vs. 56.8%, P = 0.898). The proportion of multidrug-resistant (MDR) pathogens was high in both groups. CONCLUSION Empiric anti-pseudomonal fluoroquinolone combination therapy showed no survival benefit compared to β-lactam monotherapy in patients with HAP. Caution is needed regarding the routine combination of fluoroquinolones in the empiric treatment of HAP patients with a high risk of MDR.
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Affiliation(s)
- Moon Seong Baek
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Ae-Rin Baek
- Division of Allergy and Pulmonary Medicine, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea.
| | - Sang-Bum Hong
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Soohyun Bae
- Department of Integrated Internal Medicine, Myoungji Hospital, Hanyang University College of Medicine, Goyang, Korea
| | - Hye Kyeong Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Changhwan Kim
- Department of Internal Medicine, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea
| | - Hyun-Kyung Lee
- Department of Internal Medicine, Division of Pulmonology, Allergy and Critical Care Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Woo Hyun Cho
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Internal Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Jin Hyoung Kim
- Division of Respiratory and Critical Care Medicine, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Youjin Chang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Inje University Sanggye Paik Hospital, Seoul, Korea
| | - Heung Bum Lee
- Department of Internal Medicine, Research Center for Pulmonary Disorders, Jeonbuk National University Hospital, Jeonju, Korea
| | - Hyun-Il Gil
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Beomsu Shin
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Kwang Ha Yoo
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Jae Young Moon
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Chungnam National University College of Medicine, Sejong Hospital, Sejong, Korea
| | - Jee Youn Oh
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Kyung Hoon Min
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Kyeongman Jeon
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Feng DY, Zhou JX, Li X, Wu WB, Zhou YQ, Zhang TT. Differentiation Between Acinetobacter Baumannii Colonization and Infection and the Clinical Outcome Prediction by Infection in Lower Respiratory Tract. Infect Drug Resist 2022; 15:5401-5409. [PMID: 36119640 PMCID: PMC9480586 DOI: 10.2147/idr.s377480] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 09/07/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Acinetobacter baumannii is the most common microorganism in sputum cultures from long-term hospitalized patients and is often the cause of hospital-acquired pneumonia (HAP), which is usually associated with poor prognosis and high mortality. It is sometimes difficult to distinguish between A. baumannii infection and colonization. This study aimed to evaluate factors that differentiate infection from colonization and predict mortality in patients with nosocomial pneumonia caused by A. baumannii. Patients and Methods The data used in this study were collected in our hospital between January 2018 and December 2020 from patients whose sputum cultures were positive for A. baumannii. Results A total of 714 patients were included, with 571 in the infection group and 143 in the colonization group. The in-hospital mortality rate in the infection group was 20.5%. Univariate and multivariate logistic regression analyses showed that age, total number of inpatient departments, absolute neutrophil count, and C-reactive protein (CRP) level helped distinguish between infection and colonization. The area under the receiver operating characteristic curve (ROC) of the identification model was 0.694. In the infection group, age, Charlson comorbidity score, neutrophil-to-lymphocyte ratio, blood urea nitrogen/albumin ratio, CRP level, presence of multidrug resistance, and clinical pulmonary infection score (≥6) ratio were associated with in-hospital mortality. The area under the ROC curve for the prediction model was 0.828. The top three drug resistance rates in the infection group were 100% (cefazolin), 98.77% (ceftriaxone), and 71.8% (cefuroxime). Conclusion The combination of common parameters helps identify A. baumannii respiratory tract infection or colonization. Several novel predictors can be used to predict the risk of death from A. baumannii pneumonia to reduce mortality. The drug resistance of A. baumannii remains high.
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Affiliation(s)
- Ding-Yun Feng
- Department of Pulmonary and Critical Care Medicine, Third Affiliated Hospital of Sun Yat-Sen University, Institute of Respiratory Diseases of Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Jian-Xia Zhou
- Department of Pulmonary and Critical Care Medicine, Third Affiliated Hospital of Sun Yat-Sen University, Institute of Respiratory Diseases of Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Xia Li
- Department of Pulmonary and Critical Care Medicine, Third Affiliated Hospital of Sun Yat-Sen University, Institute of Respiratory Diseases of Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Wen-Bin Wu
- Department of Pulmonary and Critical Care Medicine, Third Affiliated Hospital of Sun Yat-Sen University, Institute of Respiratory Diseases of Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Yu-Qi Zhou
- Department of Pulmonary and Critical Care Medicine, Third Affiliated Hospital of Sun Yat-Sen University, Institute of Respiratory Diseases of Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Tian-Tuo Zhang
- Department of Pulmonary and Critical Care Medicine, Third Affiliated Hospital of Sun Yat-Sen University, Institute of Respiratory Diseases of Sun Yat-Sen University, Guangzhou, People's Republic of China
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Liu L, Liu C, Cai J, Chen J, Chen J, Fu Y, Yi K, Wang H, Li X. Relationship Between Invasive Fungal Infection and Hypostatic Pneumonia: A Prospective Cohort Study. Front Microbiol 2022; 13:859359. [PMID: 35794923 PMCID: PMC9251507 DOI: 10.3389/fmicb.2022.859359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 04/26/2022] [Indexed: 11/28/2022] Open
Abstract
Background The short-term mortality of hypostatic pneumonia (HP) is very high, and the treatment outcome is poor. The clinical diagnosis and treatment are primarily focused on bacterial and viral infection, ignoring the role of fungal infection at present. This study aims to validate the relationship between Invasive Fungal Infections (IFI) and HP. Methods In the cross-sectional study, a total of 11,371 participants have been enrolled. In the prospective cohort study, 4,441 individuals have been included at baseline and followed up from 2015 to 2019 with a total person years of 8,484.65. The standard procedures were used to assess questionnaire investigations, laboratory testing, and anthropometric indicators. For data analysis, logistic regression, restricted cubic spline, log-rank regression, Cox regression, and linear mixed effects model were applied to assess the relationship between IFI and HP risk longitudinally. Results In the cross-sectional study, elevated β-D-Glucan (BDG) concentrations are associated with a higher risk of HP prevalence in the total population, men, and women (ORT3 vs.T1 [95% CIs]: 2.12 [1.55, 2.91]; 2.01 [1.35, 2.99]; 2.34 [1.39, 3.94]), which were verified by a dose–effect relationship in the restricted cubic spline model. In the cohort study, Cox and Log-rank regression showed that the elevated BDG concentrations are associated with a significantly higher risk of HP incidence than participants with lower BDG concentrations (HRT3 vs.T1 [95% CIs]: 2.72 [1.36, 5.43], pLog–rank = 0.0086). During 5 years, the globulin (GLB) and C-reactive protein (CRP) were always on the top in the highest category of BDG concentrations. Between low and high BDG concentration, the total trend of GLB concentration was falling and the total trend of CRP concentration was rising with the increase of years (all the p-values < 0.0001). Conclusion In this study, IFI is associated with a higher risk of HP, with time sequence and related mechanisms requiring further investigation in the future.
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Affiliation(s)
- Lin Liu
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chang Liu
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jianrong Cai
- Department of Ultrasound, Chongming Branch, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiayun Chen
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jie Chen
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuanyuan Fu
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Kexin Yi
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hui Wang
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- *Correspondence: Hui Wang,
| | - Xue Li
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Xue Li,
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Cardoso R, Parola V, Neves H, Bernardes RA, Duque FM, Mendes CA, Pimentel M, Caetano P, Petronilho F, Albuquerque C, Sousa LB, Malça C, Durães R, Xavier W, Parreira P, Apóstolo J, Cruz A. Physical Rehabilitation Programs for Bedridden Patients with Prolonged Immobility: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116420. [PMID: 35682005 PMCID: PMC9180781 DOI: 10.3390/ijerph19116420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 05/19/2022] [Accepted: 05/21/2022] [Indexed: 12/04/2022]
Abstract
Bedridden patients usually stay in bed for long periods, presenting several problems caused by immobility, leading to a long recovery process. Thus, identifying physical rehabilitation programs for bedridden patients with prolonged immobility requires urgent research. Therefore, this scoping review aimed to map existing physical rehabilitation programs for bedridden patients with prolonged immobility, the rehabilitation domains, the devices used, the parameters accessed, and the context in which these programs were performed. This scoping review, guided by the Joanna Briggs Institute’s (JBI) methodology and conducted in different databases (including grey literature), identified 475 articles, of which 27 were included in this review. The observed contexts included research institutes, hospitals, rehabilitation units, nursing homes, long-term units, and palliative care units. Most of the programs were directed to the musculoskeletal domain, predominantly toward the lower limbs. The devices used included lower limb mobilization, electrical stimulation, inclined planes, and cycle ergometers. Most of the evaluated parameters were musculoskeletal, cardiorespiratory, or vital signs. The variability of the programs, domains, devices and parameters found in this scoping review revealed no uniformity, a consequence of the personalization and individualization of care, which makes the development of a standard intervention program challenging.
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Affiliation(s)
- Remy Cardoso
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3000 Coimbra, Portugal; (H.N.); (R.A.B.); (F.M.D.); (C.A.M.); (M.P.); (F.P.); (C.A.); (L.B.S.); (P.P.); (J.A.)
- Correspondence: (R.C.); (V.P.); (A.C.)
| | - Vitor Parola
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3000 Coimbra, Portugal; (H.N.); (R.A.B.); (F.M.D.); (C.A.M.); (M.P.); (F.P.); (C.A.); (L.B.S.); (P.P.); (J.A.)
- Portugal Centre for Evidence Based Practice: A JBI Centre of Excellence (PCEBP), 3000 Coimbra, Portugal
- Correspondence: (R.C.); (V.P.); (A.C.)
| | - Hugo Neves
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3000 Coimbra, Portugal; (H.N.); (R.A.B.); (F.M.D.); (C.A.M.); (M.P.); (F.P.); (C.A.); (L.B.S.); (P.P.); (J.A.)
- Portugal Centre for Evidence Based Practice: A JBI Centre of Excellence (PCEBP), 3000 Coimbra, Portugal
| | - Rafael A. Bernardes
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3000 Coimbra, Portugal; (H.N.); (R.A.B.); (F.M.D.); (C.A.M.); (M.P.); (F.P.); (C.A.); (L.B.S.); (P.P.); (J.A.)
| | - Filipa Margarida Duque
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3000 Coimbra, Portugal; (H.N.); (R.A.B.); (F.M.D.); (C.A.M.); (M.P.); (F.P.); (C.A.); (L.B.S.); (P.P.); (J.A.)
- Portugal Centre for Evidence Based Practice: A JBI Centre of Excellence (PCEBP), 3000 Coimbra, Portugal
| | - Carla A. Mendes
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3000 Coimbra, Portugal; (H.N.); (R.A.B.); (F.M.D.); (C.A.M.); (M.P.); (F.P.); (C.A.); (L.B.S.); (P.P.); (J.A.)
| | - Mónica Pimentel
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3000 Coimbra, Portugal; (H.N.); (R.A.B.); (F.M.D.); (C.A.M.); (M.P.); (F.P.); (C.A.); (L.B.S.); (P.P.); (J.A.)
| | - Pedro Caetano
- Centro Hospitalar Universitário Cova da Beira (CHUCB), 6200 Covilhã, Portugal;
| | - Fernando Petronilho
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3000 Coimbra, Portugal; (H.N.); (R.A.B.); (F.M.D.); (C.A.M.); (M.P.); (F.P.); (C.A.); (L.B.S.); (P.P.); (J.A.)
- School of Nursing, University of Minho, 4710 Braga, Portugal
| | - Carlos Albuquerque
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3000 Coimbra, Portugal; (H.N.); (R.A.B.); (F.M.D.); (C.A.M.); (M.P.); (F.P.); (C.A.); (L.B.S.); (P.P.); (J.A.)
- Health School, Polytechnic Institute of Viseu, 3500 Viseu, Portugal
| | - Liliana B. Sousa
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3000 Coimbra, Portugal; (H.N.); (R.A.B.); (F.M.D.); (C.A.M.); (M.P.); (F.P.); (C.A.); (L.B.S.); (P.P.); (J.A.)
| | - Cândida Malça
- Mechanical Engineering Department, Institute of Engineering (ISEC), Polytechnic Institute of Coimbra (IPC), 3030 Coimbra, Portugal;
- Centre for Rapid and Sustainable Product Development (CDRSP), Polytechnic Institute of Leiria (IPL), 2430 Marinha Grande, Portugal
| | - Rúben Durães
- ORTHOS SSI, Unipessoal LDA, 4809 Guimarães, Portugal;
| | | | - Pedro Parreira
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3000 Coimbra, Portugal; (H.N.); (R.A.B.); (F.M.D.); (C.A.M.); (M.P.); (F.P.); (C.A.); (L.B.S.); (P.P.); (J.A.)
| | - João Apóstolo
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3000 Coimbra, Portugal; (H.N.); (R.A.B.); (F.M.D.); (C.A.M.); (M.P.); (F.P.); (C.A.); (L.B.S.); (P.P.); (J.A.)
- Portugal Centre for Evidence Based Practice: A JBI Centre of Excellence (PCEBP), 3000 Coimbra, Portugal
| | - Arménio Cruz
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3000 Coimbra, Portugal; (H.N.); (R.A.B.); (F.M.D.); (C.A.M.); (M.P.); (F.P.); (C.A.); (L.B.S.); (P.P.); (J.A.)
- Correspondence: (R.C.); (V.P.); (A.C.)
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Mazloomirad F, Hasanzadeh S, Sharifi A, Nikbakht G, Roustaei N, Khoramrooz SS. Identification and detection of pathogenic bacteria from patients with hospital-acquired pneumonia in southwestern Iran; evaluation of biofilm production and molecular typing of bacterial isolates. BMC Pulm Med 2021; 21:408. [PMID: 34886838 PMCID: PMC8662843 DOI: 10.1186/s12890-021-01773-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 11/29/2021] [Indexed: 12/01/2022] Open
Abstract
Background Hospital-acquired pneumonia (HAP) is the second most common nosocomial infection in intensive care units (ICUs). The present study aims to determine the prevalence of pathogenic bacteria, their biofilm formation, and molecular typing from patients with HAP in southwestern Iran. Methods Fifty-eight patients with HAP participated in this cross-sectional study. Sputum and endotracheal aspirate were collected from each patient for isolation and detection of bacteria. Biofilm formation was evaluated using Congo red agar or Microtiter plate assay. The antimicrobial susceptibility patterns of the isolates were investigated. The multiplex polymerase chain reaction (M-PCR) technique was used to determine the Staphylococcal Cassette Chromosome mec (SCCmec) types of methicillin-resistant Staphylococcus aureus (MRSA) strains. All S. aureus isolates were typed using the agr typing method. A repetitive element sequence-based PCR (rep-PCR) typing method was used for typing of Gram-negative bacteria. Data were analyzed using the Statistical Package for the Social Sciences (SPSS) software version 15 and the chi-square test. Results Bacteria were isolated in 52 (89.7%) of patients. Acinetobacter baumannii (A. baumannii) was the most prevalent organism (37%), followed by S. aureus, Pseudomonas aeruginosa (P. aeruginosa), and Escherichia coli (E. coli). Using the PCR method, 56 bacteria were detected. A. baumannii was the most prevalent (35.7%) organism. A. baumannii and P. aeruginosa were biofilm-producing. All Gram-negative isolates were colistin-sensitive, and most of the A. baumannii isolates were multidrug-resistant (MDR). MRSA was identified in 12 (80%) S. aureus isolates, and 91.6% of MRSA were SCCmec type III. The agr type III was the most predominant. The rep-PCR analysis showed seven different patterns in 20 A. baumannii, six patterns in 13 P. aeruginosa, and four patterns in 6 E. coli. Conclusion A. baumannii was more prevalent than S. aureus in ventilator-associated pneumonia (VAP), while S. aureus is a major pathogen in non-ventilator hospital-acquired pneumonia (NV-HAP), possibly due to the tendency of the former to aquatic environments. Based on the rep-PCR typing method, it was concluded that bacteria were transmitted from patients or healthcare workers among different wards. Colistin can be used as a treatment in Gram-negative MDR isolates.
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Affiliation(s)
- Farzad Mazloomirad
- Student Research Committee, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Sajad Hasanzadeh
- Department of Internal Medicine, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Asghar Sharifi
- Cellular and Molecular Research Center, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Gordafarin Nikbakht
- Department of Infectious Diseases, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Narges Roustaei
- Department of Epidemiology and Biostatistics, School of Health and Nutrition Sciences, Social Determinants of Health Research Center, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Seyed Sajjad Khoramrooz
- Cellular and Molecular Research Center, Yasuj University of Medical Sciences, Yasuj, Iran. .,Department of Microbiology, Yasuj University of Medical Sciences, Yasuj, Iran.
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Assessing the Impact of Gender and COPD on the Incidence and Mortality of Hospital-Acquired Pneumonia. A Retrospective Cohort Study Using the Spanish National Discharge Database (2016-2019). J Clin Med 2021; 10:jcm10225453. [PMID: 34830733 PMCID: PMC8625205 DOI: 10.3390/jcm10225453] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 11/19/2021] [Accepted: 11/20/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND We aim to analyze incidence and outcomes of patients hospitalized with hospital-acquired pneumonia (HAP) according to chronic obstructive pulmonary disease (COPD) status and sex in Spain (2016-2019). METHODS We conducted a retrospective cohort study using national hospital discharge data of patients ≥40 years with a primary diagnosis of HAP, using the specific diagnostics of non-ventilator (NV)-HAP and ventilator-associated pneumonia (VAP). RESULTS We identified 37,029 patients with HAP ((NV)-HAP 87.28%, VAP 12.72%), 13.40% with COPD. HAP incidence increased over time, but only in subjects without COPD (p < 0.001). In women, incidence of HAP and (NV)-HAP was similar regardless of COPD status, but VAP incidence was lower in COPD women (p = 0.007). In men, the incidence of (NV)-HAP was significantly higher in those with COPD, while VAP incidence was lower in COPD men (p < 0.001). The in-hospital mortality (IHM) was similar in men and women with and without COPD. The risk of dying in hospital increased with age, congestive heart failure, cancer, and dialysis among men and women with COPD. Men that underwent surgery had a lower risk of IHM. VAP increased 2.58-times the probability of dying in men and women. Finally, sex was not associated with IHM among COPD patients. CONCLUSIONS Incidence of HAP was significantly higher in COPD patients than in those without COPD, at the expense of (NV)-HAP but not of VAP. When stratifying by sex, we found that the difference was caused by men. IHM was similar in COPD and non-COPD patients, with no significant change overtime. In addition, sex was not associated with IHM.
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