Prognostic factors of the patients admitted to intensive care unit with nursing and healthcare-associated pneumonia

Abstract

Introduction: Nursing and healthcare-associated pneumonia(NHCAP) is a respiratory infection acquired through outpatient contact with the health system. We aimed to ascertain the clinical characteristics, outcomes and prognostic factor of NHCAP patients admitted to ICU.

Materials and Methods: We reviewed NHCAP patients admitted to ICU of tertiary hospital from January 2008 to December 2012. NHCAP was separated from A to D according to nursing-home residence, previous hospitalization, physically disabled, and continuously receiving outpatient endovascular therapy. The severity of pneumonia was assessed by using the pneumonia severity index(PSI) and CURB-65. The 30-day mortality was evaluated as a primary endpoint.

Results: 428 patients(men, 67.1%) were enrolled. The median age was 73.0 year-old. Median APACHE II and PSI score were 23.0(19–27) and 144.0(130–158) respectively. Thirty-day mortality was 25.5% and duration of ICU stay was 9.0 days. Mortality (P=0.349) had no significant difference among four groups although duration of ICU stay(P=0.008) was significantly longer in group C and D. When we performed multivariate logistic analysis, PSI score(OR 1.011 95%CI 1.000-1.022, P=0.040), serum HCO₃^-level(OR 0.956 95%CI 0.920-0.993, P=0.022), multidrug-resistant(MDR) pathogens including ESBL-producing Klebsiella pneumoniae(OR 2.688 95%CI 1.237-5.840, P=0.016), MDR Acinetobacter baumannii(OR 3.081 95%CI 1.504-6.311, P=0.002) were significantly associated with 30-day mortality.

Conclusion: ESBL-producing K. pneumoniae and MDR A. baumannii were significantly associated with 30-day mortality in NHCAP in ICU patients, therefore should be considered as prognostic factors.