Community-Acquired Pneumonia

Chest Imaging ◽

10.1093/med/9780199858064.003.0034 ◽

2019 ◽

pp. 191-195

Author(s):

Sonia L. Betancourt

Keyword(s):

Lower Respiratory Tract ◽

Bronchopleural Fistula ◽

Lung Parenchyma ◽

Community Acquired Pneumonia ◽

Necrotizing Pneumonia ◽

Term Care ◽

Fluid Analysis ◽

Care Facilities ◽

Acquired Immunodeficiency

Pneumonia refers to acute inflammation of the lower respiratory tract and lung parenchyma. Community Acquired Pneumonia (CAP) refers to pneumonia acquired outside of hospitals or long-term care facilities in patients without known inherited or acquired immunodeficiency or active cancer or within 48 hours after hospital admission. Chest radiographic demonstration of airspace disease helps support the diagnosis in the appropriate clinical setting. Patients with CAP are treated with antibiotics regardless of chest radiography findings. Further evaluation with Computed tomography (CT), bronchoscopy, pleural fluid analysis, etc., are reserved for patients that do not respond to treatment or in whom complications are suspected. CT is useful in assessing complications such as empyema, bronchopleural fistula, abscess, and necrotizing pneumonia. Lung abscesses and empyema are frequently associated with aspiration pneumonia.

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Determinants of Hospital Length of Stay among Patients with Pneumonia Admitted to a Large Canadian Hospital from 1991 to 2001

Canadian Respiratory Journal ◽

10.1155/2005/628367 ◽

2005 ◽

Vol 12 (7) ◽

pp. 365-370 ◽

Cited By ~ 4

Author(s):

Margaret J McGregor ◽

J Mark FitzGerald ◽

Robert J Reid ◽

Adrian R Levy ◽

Michael Schulzer ◽

...

Keyword(s):

Length Of Stay ◽

Long Term Care ◽

Care Facility ◽

Community Acquired Pneumonia ◽

Hospital Length Of Stay ◽

Term Care ◽

Term Care Facility ◽

Long Term Care Facility ◽

Care Facilities

BACKGROUND: Pneumonia is a common reason for hospital admission, and the cost of treatment is primarily determined by length of stay (LOS).OBJECTIVES: To explore the changes to and determinants of hospital LOS for patients admitted for the treatment of community-acquired pneumonia over a decade of acute hospital downsizing.METHODS: Data were extracted from the database of Vancouver General Hospital, Vancouver, British Columbia, on patients admitted with community-acquired pneumonia (International Classification of Diseases, Ninth Revision, Clinical Modification codes 481.xx, 482.xx, 483.xx, 485.xx and 486.xx) from January 1, 1991 to March 31, 2001. The effects of sociodemographic factors, the specialty of the admitting physician (family practice versus specialist), admission from and/or discharge to a long-term care facility (nursing home) and year of admission, adjusted for comorbidity, illness severity measures and other potential confounders were examined. Longitudinal changes in these factors over the 10-year period were also investigated.RESULTS: The study population (n=2495) had a median age of 73 years, 53% were male and the median LOS was six days. Adjusted LOS was longer for women (10% increase, 95% CI 3 to 16), increasing age group (7% increase, 95% CI 4 to 10), admission under a family physician versus specialist (42% increase, 95% CI 32 to 52) and admission from home with subsequent discharge to a long-term care facility (75% increase, 95% CI 47 to 108). Adjusted hospital LOS decreased by an estimated 2% (95% CI 1 to 3) per annum. The mean age at admission and the proportion admitted from long-term care facilities both increased significantly over the decade (P<0.05).CONCLUSIONS: Results suggest that the management of hospitalized patients with pneumonia changed substantially between 1991 and 2001. The interface of long-term care facilities with acute care would be an important future area to explore potential efficiencies in caring for patients with pneumonia.

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Variation in Mortality Rates Among Long-Term Care Facilities for Residents With Lower Respiratory Tract Infection

Infection Control and Hospital Epidemiology ◽

10.1086/590123 ◽

2008 ◽

Vol 29 (8) ◽

pp. 754-759 ◽

Cited By ~ 4

Author(s):

L. E. Nicolle ◽

S. Mubareka ◽

A. Simor ◽

B. Liu ◽

S. McNeil ◽

...

Keyword(s):

Mortality Rate ◽

Tract Infection ◽

Respiratory Tract ◽

Respiratory Tract Infection ◽

Lower Respiratory Tract Infection ◽

Lower Respiratory Tract ◽

Long Term Care ◽

Term Care ◽

Care Facilities

Objective.To identify variables contributing to interfacility differences in mortality among residents of long-term care facilities who have lower respiratory tract infection.Design.Multicenter, prospective, 1 -year observational study.Setting.Twenty-one long-term care facilities in 4 geographic areas of Canada.Participants.Residents of long-term care facilities prescribed antimicrobials for treatment of lower respiratory tract infection.Methods.Mortality rates were calculated for 3 definitions of lower respiratory tract infection: episodes with a clinical or radiographic diagnosis and treated with antimicrobials (definition 1); episodes with a physician diagnosis of pneumonia (definition 2); and episodes with chest radiography findings consistent with pneumonia (definition 3). Multilevel modeling was used to evaluate variables describing premorbid resident status, clinical presentation, management, and facility characteristics. Multivariable models were developed to identify independent predictors of mortality and determine whether facility-level variables remained independently associated with mortality rate after incorporation of individual-level variables.Results.Facility mortality rates varied from 0% to 17.8% for definition 1, from 0% to 47.1% for definition 2, and from 0% to 37.5% for definition 3. There were significant differences in mortality rate depending on which definition was used; for definitions 1 and 2, there were significant differences in mortality rate across facilities. Poorer premorbid resident status and a more severe presentation remained independent predictors of mortality in the multivariable analysis. There were also significantly increased mortality rates for episodes in which a fluoroquinolone was prescribed for initial treatment. For definitions 1 and 3, facility-level variables remained independently associated with mortality rate in the final multivariable model.Conclusions.Rates of mortality due to lower respiratory tract infection varied among long-term care facilities and differed within a facility, depending on the definition applied. Variables describing premorbid resident status, severity of presentation, and management did not fully explain the variation in mortality rate. Some facility-level variables remained independent predictors of mortality.

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