A prospective comparison of nursing home-acquired pneumonia with hospital-acquired pneumonia in non-intubated elderly

Maruyama, T.; Niederman, M.S.; Kobayashi, T.; Kobayashi, H.; Takagi, T.; D'Alessandro-Gabazza, C.N.; Fujimoto, H.; Gil Bernabe, P.; Hirohata, S.; Nakayama, S.; Nishikubo, K.; Yuda, H.; Yamaguchi, A.; Gabazza, E.C.; Noguchi, T.; Takei, Y.; Taguchi, O.

doi:10.1016/j.rmed.2008.03.027

« Previous Next »Respiratory Medicine
Volume 102, Issue 9 , Pages 1287-1295, September 2008

A prospective comparison of nursing home-acquired pneumonia with hospital-acquired pneumonia in non-intubated elderly

T. Maruyama
- Department of Pulmonary and Critical Care Medicine, Mie University Graduate School of Medicine, Edobashi 2-174, Tsu City, Mie Prefecture, Japan
M.S. Niederman
- Department of Medicine, Winthrop University Hospital, 222 Station Plaza N., Suite 5091, Mineola, NY 11501, USA
T. Kobayashi
- Department of Pulmonary and Critical Care Medicine, Mie University Graduate School of Medicine, Edobashi 2-174, Tsu City, Mie Prefecture, Japan
H. Kobayashi
- Department of Pulmonary and Critical Care Medicine, Mie University Graduate School of Medicine, Edobashi 2-174, Tsu City, Mie Prefecture, Japan
T. Takagi
- Department of Pulmonary and Critical Care Medicine, Mie University Graduate School of Medicine, Edobashi 2-174, Tsu City, Mie Prefecture, Japan
C.N. D'Alessandro-Gabazza
- Department of Pulmonary and Critical Care Medicine, Mie University Graduate School of Medicine, Edobashi 2-174, Tsu City, Mie Prefecture, Japan
H. Fujimoto
- Department of Pulmonary and Critical Care Medicine, Mie University Graduate School of Medicine, Edobashi 2-174, Tsu City, Mie Prefecture, Japan
P. Gil Bernabe
- Department of Gastroenterology and Hepatology, Mie University Graduate School of Medicine, Edobashi 2-174, Tsu City, Mie Prefecture, Japan
S. Hirohata
- Kinan General Hospital, 4750 Atawa, Mihama-chou, Minamimuro, Mie, 519-5293, Japan
S. Nakayama
- Kinan General Hospital, 4750 Atawa, Mihama-chou, Minamimuro, Mie, 519-5293, Japan
K. Nishikubo
- Kinan General Hospital, 4750 Atawa, Mihama-chou, Minamimuro, Mie, 519-5293, Japan
H. Yuda
- Mie Prefecture General Hospital, 5450-132 Hinaga, Yokkaichi, Mie, 510-0885, Japan
A. Yamaguchi
- Department of Pulmonary and Critical Care Medicine, Mie University Graduate School of Medicine, Edobashi 2-174, Tsu City, Mie Prefecture, Japan
E.C. Gabazza
- Department of Immunology, Mie University Graduate School of Medicine, Edobashi 2-174, Tsu City, Mie Prefecture, Japan
- Corresponding author. Department of Immunology, Mie University School of Medicine, Edobashi 2-174, Tsu city, Mie 514-8507, Japan. Tel.: +81 59 231 5017; fax: +81 59 231 5225.
T. Noguchi
- Kinan General Hospital, 4750 Atawa, Mihama-chou, Minamimuro, Mie, 519-5293, Japan
Y. Takei
- Department of Gastroenterology and Hepatology, Mie University Graduate School of Medicine, Edobashi 2-174, Tsu City, Mie Prefecture, Japan
O. Taguchi
- Department of Pulmonary and Critical Care Medicine, Mie University Graduate School of Medicine, Edobashi 2-174, Tsu City, Mie Prefecture, Japan

Received 5 January 2008; accepted 28 March 2008. published online 07 July 2008.

Summary

There are no prospective comparison of the etiology and clinical outcome between hospital-acquired pneumonia (HAP) and nursing home-acquired pneumonia (NHAP) in non-intubated elderly. This study prospectively evaluated the etiology of HAP and NHAP in non-intubated elderly. A prospective cohort study was carried out in a rural region of Japan where the population over 65 years of age represents 30% of the population. A total of 108 patients were enrolled. There were 33 patients with HAP and 75 with NHAP. Etiologic diagnosis was established in 78.8% of HAP and in 72% of NHAP patients. The most frequent pathogens were Chlamydophila pneumoniae followed by Streptococcus pneumoniae, Staphylococcus aureus and Influenza virus. The frequency of Streptococcus pneumoniae and Influenza virus was significantly higher, whereas the frequency of Staphylococcus aureus and Enterobacteriaceae was significantly lower in NHAP compared to HAP. Performance and nutritional status were significantly worse in patients with HAP than in those with NHAP. Hospital mortality was significantly lower in patients with NHAP compared to those with HAP. This study demonstrated that C. pneumoniae, Streptococcus pneumoniae, Staphylococcus aureus and Influenza virus are frequent causative agents of pneumonia in non-intubated elderly and that the responsible pathogens and clinical outcome differ between NHAP and HAP.