PT  - JOURNAL ARTICLE
AU  - Catriona Rother
AU  - Waleed Salih
AU  - James D. Chalmers
TI  - Healthcare associated pneumonia does not accurately identify potentially resistant pathogens: A systematic evaluation
DP  - 2013 Sep 01
TA  - European Respiratory Journal
PG  - 4844
VI  - 42
IP  - Suppl 57
4099  - http://erj.ersjournals.com/content/42/Suppl_57/4844.short
4100  - http://erj.ersjournals.com/content/42/Suppl_57/4844.full
SO  - Eur Respir J2013 Sep 01; 42
AB  - IntroductionHealthcare Associated Pneumonia (HCAP) has been suggested as a new category of pneumonia separate from hospital and community-acquired pneumonia (CAP). This concept is controversial. We systematically evaluated the ability of the HCAP concept to predict resistant pathogens in patients with pneumonia.MethodsSystematic review and meta-analysis of studies comparing microbiology and outcomes in patients with HCAP and CAP. Studies were pooled using a random effects model. The accuracy of HCAP for identifying MRSA, Pseudomonas aeruginosa and enterobacteriaceae were estimated using the area under the receiver operator characteristic curve (AUC).Results20 studies were included with a total of 20,181 patients. Only 7 studies were prospective and 6 were rated as high quality. All studies reported increased mortality in HCAP odds ratio 2.4 (95%CI 2.2-2.7, p<0.0001). The pooled analysis found an increased frequency of MRSA (OR 4.5 95%CI 3.4-5.8 p<0.001), P.aeruginosa (OR 3.0 95%CI 2.2-4.2 p<0.001) and enterobactericeae (OR 2.5 95%CI 1.7-3.8 p<0.001) in HCAP. HCAP had modest predictive value for resistant pathogens (AUC 0.71 95%CI 0.69-0.73) overall and poor predictive value in prospective studies (AUC 0.64 95%CI 0.62-0.67). The predictive value was not significantly better in North America (p=0.1) or Asia (p=0.09) compared to Europe. There was evidence of publication bias in the analysis of MRSA (p=0.004) and P.aeruginosa (p=0.01) using Eggers test.ConclusionHCAP is poorly predictive of resistant pathogens. Research into HCAP is affected by low study and publication bias. Our results do not support a change in management practices based on the HCAP concept.