A worldwide perspective of nursing home-acquired pneumonia compared with community-acquired pneumonia

BACKGROUND: Nursing home-acquired pneumonia (NHAP) is the leading cause of death among long-term care patients and the second most common cause of transfers to acute care facilities. The aim of this study was to characterize the incidence, microbiology, and outcomes for hospitalized patients with community-acquired pneumonia (CAP) and NHAP. METHODS: A secondary analysis of 5,160 patients from the Community-Acquired Pneumonia Organization database was performed. World regions were defined as the United States and Canada (I), Latin America (II), and Europe (III). RESULTS: From a total of 5,160 hospitalized patients with CAP, NHAP was identified in 287 (5.6%) patients. Mean age was 80 y. NHAP distribution by region was 6% in region I, 3% in region II, and 7% in region III. Subjects with NHAP had higher frequencies of neurological disease, diabetes mellitus, congestive heart failure, and renal failure than did subjects with CAP (P < .001). ICU admission was required in 32 (12%) subjects. Etiology was defined in 68 (23%) subjects with NHAP and 1,300 (27%) with CAP. The most common pathogens identified in NHAP included Streptococcus pneumoniae (31%), Staphylococcus species (31%), and Pseudomonas aeruginosa (7%). Presentation of NHAP more frequently included pleural effusions (34% vs 21%, P < .001) and multilobar involvement (31% vs 24%, P < .001). Thirty-day hospital mortality was statistically greater among subjects with NHAP than among those with CAP (42% vs 18%, P < .001). CONCLUSIONS: Worldwide, only a very small proportion of hospitalized patients with CAP present with NHAP; the poor outcomes for these patients may be due primarily to a higher number of comorbidities compared with patients without NHAP.