Economic Burden of Ventilator-Associated, Hospital-Acquired, Healthcare-Associated and Community-Acquired Pneumonia in the Hospital Setting

Pneumonia can be classified as: community-acquired pneumonia (CAP), hospital-acquired pneumonia (HAP), ventilator-associated pneumonia (VAP), healthcare-associated pneumonia (HCAP), and pneumonia in immunosuppressed patients. Although the above are similar pathologically, they are very different from a clinical perspective. Chest radiography is often performed to support the diagnosis and to determine the extent of involvement prior to the onset of therapy. Radiography should not be performed in the short term in patients who are improving clinically as it can lead to the misdiagnosis of treatment failure. Chest radiography in patients treated for pneumonia should only be obtained before 4-6 weeks after the onset of therapy if there is a failure of clinical response or if complications of pneumonia are clinically suspected. The majority of pneumonias will resolve after 6 weeks of appropriate antibiotic therapy.

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Clinical characteristics of patients with pneumonia caused by Klebsiella pneumoniae in Taiwan and prevalence of antimicrobial-resistant and hypervirulent strains: a retrospective study

Antimicrobial Resistance and Infection Control ◽

10.1186/s13756-019-0660-x ◽

2020 ◽

Vol 9 (1) ◽

Cited By ~ 2

Author(s):

Chih-Han Juan ◽

Shih-Yu Fang ◽

Chia-Hsin Chou ◽

Tsung-Ying Tsai ◽

Yi-Tsung Lin

Keyword(s):

Retrospective Study ◽

Klebsiella Pneumoniae ◽

Clinical Characteristics ◽

Community Acquired Pneumonia ◽

Drug Resistant ◽

Hospital Acquired Pneumonia ◽

Resistant Strains ◽

Healthcare Associated ◽

Drug Resistant Strains ◽

Hospital Acquired

Abstract Background We aimed to compare the clinical characteristics of patients with community-acquired pneumonia (CAP), healthcare-associated pneumonia (HCAP), and hospital-acquired pneumonia (HAP) caused by Klebsiella pneumoniae and analyze the antimicrobial resistance and proportion of hypervirluent strains of the microbial isolates. Methods We conducted a retrospective study on patients with pneumonia caused by K. pneumoniae at the Taipei Veterans General Hospital in Taiwan between January 2014 and December 2016. To analyze the clinical characteristics of these patients, data was extracted from their medical records. K. pneumoniae strains were subjected to antimicrobial susceptibility testing, capsular genotyping and detection of the rmpA and rmpA2 genes to identify hypervirulent strains. Results We identified 276 patients with pneumonia caused by K. pneumoniae, of which 68 (24.6%), 74 (26.8%), and 134 (48.6%) presented with CAP, HCAP, and HAP, respectively. The 28-day mortality was highest in the HAP group (39.6%), followed by the HCAP (29.7%) and CAP (27.9%) groups. The HAP group also featured the highest proportion of multi-drug resistant strains (49.3%), followed by the HCAP (36.5%) and CAP groups (10.3%), while the CAP group had the highest proportion of hypervirulent strains (79.4%), followed by the HCAP (55.4%) and HAP groups (41.0%). Conclusion Pneumonia caused by K. pneumoniae was associated with a high mortality. Importantly, multi-drug resistant strains were also detected in patients with CAP. Hypervirulent strains were prevalent in all 3 groups of pneumonia patients, even in those with HAP.

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MRSA Community-acquired Pneumonia: Non COVID-19 Related Bilateral Ground-glass Opacities

10.33169/biomcase.bacroaoj-2-121 ◽

2021 ◽

Vol 2 (2) ◽

pp. 77-79

Author(s):

Nasam Alfraji

Keyword(s):

Unusual Case ◽

Hospital Setting ◽

Community Acquired Pneumonia ◽

Ground Glass ◽

Drug Resistant ◽

Poor Clinical Outcome ◽

Hospital Acquired Infections ◽

Keywords Mrsa ◽

High Index Of Suspicion ◽

Hospital Acquired

Methicillin-resistant staph aureus (MRSA) has been known to cause severe hospital-acquired infections with its multi-drug resistant nature. MRSA Infections could quickly escalate into severe sepsis resulting in death, if not recognized and treated abruptly. This pathogen uncommonly causes Community-Acquired Pneumonia (CAP), which can lead to under treatment due to delayed coverage with anti-MRSA antibiotics resulting in poor clinical outcome. We herein describe an unusual case of MRSA CAP during COVID-19 pandemic in an 80-year-old male who was unresponsive and found to be in septic shock, intubated outside the hospital setting, and then brought to intensive care unit for further management. Laboratory and radiographic studies revealed MRSA in sputum culture and extensive bilateral consolidation with bilateral ground glass opacities and pleural effusions on imaging. Our patient was successfully treated with linezolid and extubated within 48 hours with a favorable outcome. High index of suspicion and a timely coverage with anti-MRSA antibiotics would reduce mortality and lead to a better outcome in otherwise fatal infection. Keywords: MRSA; Community-acquired pneumonia; Respiratory failure; Critical care; Case report

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High frequency of Gram-negative drug-resistant bacteria both in community- and hospital-acquired bloodstream infections (BSI) in a hospital setting from northern Italy

10.26226/morressier.56d6be74d462b80296c974b5 ◽

2016 ◽

Author(s):

Ottavia Viganò

Keyword(s):

High Frequency ◽

Hospital Setting ◽

Bloodstream Infections ◽

Northern Italy ◽

Resistant Bacteria ◽

Drug Resistant ◽

Gram Negative ◽

Drug Resistant Bacteria ◽

Hospital Acquired

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A 6-Year Review of Carbapenemase-Producing Organisms in Alberta, Canada

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.608 ◽

2020 ◽

Vol 41 (S1) ◽

pp. s104-s105

Author(s):

Ye Shen ◽

Jennifer Ellison ◽

Uma Chandran ◽

Sumana Fathima ◽

Jamil Kanji ◽

...

Keyword(s):

Acute Care ◽

Management Practices ◽

Hospital Setting ◽

Data Sources ◽

Infection Prevention And Control ◽

Term Care ◽

Carbapenemase Gene ◽

Care Facilities ◽

Hospital Acquired ◽

Alberta Health

Background: This review describes the epidemiology of carbapenemase-producing organisms (CPO) in both the community and hospitalized populations in the province of Alberta. Methods: Newly identified CPO-positive individuals from April 1, 2013, to March 31, 2018, were retrospectively reviewed from 3 data sources, which shared a common provincial CPO case definition: (1) positive CPO results from the Provincial Laboratory for Public Health, which provides all referral and confirmatory CPO testing, (2) CPO cases reported to Alberta Health, and (3) CPO surveillance from Alberta Health Services Infection Prevention and Control (IPC). The 3 data sources were collated, and initial CPO cases were classified according to their likely location of acquisition: hospital-acquired, hospital-identified, on admission, and community-identified. Risk factors and adverse outcomes were obtained from linkage to administrative data. Results: In total, 171 unique individuals were newly identified with a first-time CPO case. Also, 15% (25 of 171) were hospital-acquired (HA), 21% (36 of 171) were hospital-identified (HI), 33% (57 of 171) were on admission, and 31% (53 of 171) were community identified. Overall, 9% (5 of 171) resided in long-term care facilities. Of all patients in acute-care facilities, 30% (35 of 118) had infections and 70% were colonized. Overall, 38% (65 of 171) had an acute-care admission in the 1 year prior to CPO identification; 59% (63 of 106) of those who did not have a previous admission had received healthcare outside Alberta. A large proportion of on-admission cases (81%, 46 of 57) and community-identified (66%, 33 of 53) cases did not have any acute-care admissions in Alberta in the previous year. Overall, 10% (14 of 171) had ICU admissions in Alberta within 30 days of CPO identification, and 5% (8 of 171) died within 30 days. The most common carbapenemase gene identified was NDM-1 (53%, 90 of 171). Conclusions: These findings highlight the robust nature of Alberta’s provincial CPO surveillance network. We reviewed 3 different databases (laboratory, health ministry, IPC) to obtain comprehensive data to better understand the epidemiology of CPO in both the community and hospital settings. More than half of the individuals with CPO were initially identified in the community or on admission. Most had received healthcare outside Alberta, and no acute-care admissions occurred in Alberta in the previous year. It is important to be aware of the growing reservoir of CPO outside the hospital setting because it could impact future screening and management practices.Funding: NoneDisclosures: None

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1476. Impact of an Educational Campaign on Rates of Sputum Culture Acquisition as an Opportunity for Antibiotic De-escalation

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.1657 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S739-S739

Author(s):

Jessica Snawerdt ◽

Derek N Bremmer ◽

Dustin R Carr ◽

Thomas L Walsh ◽

Tamara Trienski ◽

...

Keyword(s):

Length Of Stay ◽

Hospital Mortality ◽

Community Acquired Pneumonia ◽

Sputum Culture ◽

Post Intervention ◽

Significant Difference ◽

Educational Campaign ◽

The Difference ◽

Hospital Acquired ◽

Culture Acquisition

Abstract Background The 2019 community-acquired pneumonia (CAP) guidelines recommend obtaining a sputum culture in patients who are empirically treated for methicillin-resistant Staphylococcus aureus (MRSA) or Pseudomonas aeruginosa to assist clinicians in optimizing antimicrobial therapy. A previous study at our institution found respiratory cultures were rarely obtained in patients with CAP. As a result of these findings, an educational campaign was implemented to promote the use of an induced sputum protocol. Methods This was a multicenter, retrospective cohort study that included patients who were ≥18 years of age, had a diagnosis of CAP, and received ≥48 hours of anti-pseudomonal antibiotics. Patients were excluded if mechanically ventilated within 48 hours of admission or diagnosed with hospital-acquired or ventilator-associated pneumonia. Patients were grouped into pre- and post-intervention time periods. The intervention involved education on obtaining respiratory cultures including technique on induced sputums and updates to CAP order sets. The primary outcome was the rate of sputum culture acquisition. Secondary outcomes included duration of anti-pseudomonal and anti-MRSA therapy, in-hospital mortality, and length of stay. Results A total of 143 patients met inclusion criteria, 72 in the pre-implementation group and 71 in the post-implementation group. Baseline characteristics were similar between the two groups. More patients in the post-implementation group had a sputum culture obtained but the difference was not statistically significant (38.9% vs 53.5%; p=0.08). Anti-pseudomonal therapy was continued for an average of 5.6 days pre-implementation and 5.2 days post-implementation (p=0.499). There was also not a significant difference in anti-MRSA duration between the two groups (3.4 days vs 3.2 days; p=0.606). In-hospital mortality and length of stay were similar between the two groups. Conclusion An educational campaign focusing on the acquisition of induced sputums led to an increase in rates of sputum cultures collected. However, this did not correlate with a decrease in duration of anti-MRSA or anti-pseudomonal therapy. Further interventions should be made to optimize de-escalation of broad spectrum antibiotics based on sputum culture results. Disclosures All Authors: No reported disclosures

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Impact of the Centers for Medicare and Medicaid Services Hospital-Acquired Conditions Policy on Billing Rates for 2 Targeted Healthcare-Associated Infections

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2015.86 ◽

2015 ◽

Vol 36 (8) ◽

pp. 871-877 ◽

Cited By ~ 13

Author(s):

Alison Tse Kawai ◽

Michael S. Calderwood ◽

Robert Jin ◽

Stephen B. Soumerai ◽

Louise E. Vaz ◽

...

Keyword(s):

New York ◽

Odds Ratio ◽

Times Series ◽

Hospital Acquired Conditions ◽

Medicare Patients ◽

Study Population ◽

Tract Infections ◽

Additional Payment ◽

Healthcare Associated ◽

Hospital Acquired

BACKGROUNDThe 2008 Centers for Medicare & Medicaid Services hospital-acquired conditions policy limited additional payment for conditions deemed reasonably preventable.OBJECTIVETo examine whether this policy was associated with decreases in billing rates for 2 targeted conditions, vascular catheter-associated infections (VCAI) and catheter-associated urinary tract infections (CAUTI).STUDY POPULATIONAdult Medicare patients admitted to 569 acute care hospitals in California, Massachusetts, or New York and subject to the policy.DESIGNWe used an interrupted times series design to assess whether the hospital-acquired conditions policy was associated with changes in billing rates for VCAI and CAUTI.RESULTSBefore the policy, billing rates for VCAI and CAUTI were increasing (prepolicy odds ratio per quarter for VCAI, 1.17 [95% CI, 1.11–1.23]; for CAUTI, 1.19 [1.16–1.23]). The policy was associated with an immediate drop in billing rates for VCAI and CAUTI (odds ratio for change at policy implementation for VCAI, 0.75 [95% CI, 0.69–0.81]; for CAUTI, 0.87 [0.79–0.96]). In the postpolicy period, we observed a decreasing trend in the billing rate for VCAI and a leveling-off in the billing rate for CAUTI (postpolicy odds ratio per quarter for VCAI, 0.98 [95% CI, 0.97–0.99]; for CAUTI, 0.99 [0.97–1.00]).CONCLUSIONSThe Centers for Medicare & Medicaid Services hospital-acquired conditions policy appears to have been associated with immediate reductions in billing rates for VCAI and CAUTI, followed by a slight decreasing trend or leveling-off in rates. These billing rates, however, may not correlate with changes in clinically meaningful patient outcomes and may reflect changes in coding practices.Infect. Control Hosp. Epidemiol. 2015;36(8):871–877

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Healthcare associated pneumonia: An old concept at a hospital with high prevalence of antimicrobial resistance

MedPharmRes ◽

10.32895/ump.mpr.5.2.4 ◽

2021 ◽

Vol 5 (2) ◽

pp. 17-21

Author(s):

Lam Nguyen-Ho ◽

Duong Hoang-Thai ◽

Vu Le-Thuong ◽

Ngoc Tran-Van

Keyword(s):

Risk Factor ◽

Antimicrobial Resistance ◽

Multidrug Resistant ◽

Community Acquired Pneumonia ◽

Resistant Organism ◽

Healthcare Associated Infection ◽

Female Ratio ◽

High Prevalence ◽

Need To Evaluate ◽

Healthcare Associated

Background: One of several reasons that the concept of healthcare-associated pneumonia (HCAP) was dismissed was the same presence of multidrug resistant organism (MDRO) between community-acquired pneumonia and HCAP at countries with the low prevalence of antimicrobial resistance (AMR). However, this finding could be unsuitable for countries with the high rates of AMR. Methods: A prospective observational study was conducted at the respiratory department of Cho Ray hospital from September 2015 to April 2016. All adult patients suitable for community acquired pneumonia (CAP) with risk factor for healthcare-associated infection were included. Results: We found out 130 subjects. The median age was 71 years (interquartile range 57-81). The male/female ratio was 1.55:1. Prior hospitalization was the most common risk factor for healthcare-associated infection. There were 35 cases (26.9%) with culture-positive (sputum and/or bronchial lavage). Isolated bacteria included Pseudomonas aeruginosa (9 cases), Klebsiella pneumoniae (9 cases), Escherichia coli (4 cases), Acinetobacter baumannii (6 cases), and Staphylococcus aureus (7 cases) with the characteristic of AMR similar to the bacterial spectrum associated with hospital-acquired pneumonia. Conclusion: MDROs were detected frequently in CAP patients with risk factor for healthcare-associated infection at the hospital with the high prevalence of AMR. This requires the urgent need to evaluate risk factors for MDRO infection in community-onset pneumonia when the concept of HCAP is no longer used.

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Antibiotic Prescribing for Adults Hospitalized in the Etiology of Pneumonia in the Community Study

Open Forum Infectious Diseases ◽

10.1093/ofid/ofx088 ◽

2017 ◽

Vol 4 (2) ◽

Cited By ~ 6

Author(s):

Sara Tomczyk ◽

Seema Jain ◽

Anna M Bramley ◽

Wesley H Self ◽

Evan J Anderson ◽

...

Keyword(s):

Antibiotic Use ◽

Community Acquired Pneumonia ◽

Community Study ◽

Antibiotic Prescribing ◽

Beta Lactam ◽

First Line ◽

Factors Associated ◽

Admission Ward ◽

Healthcare Associated ◽

To Receive

Abstract Background Community-acquired pneumonia (CAP) 2007 guidelines from the Infectious Diseases Society of America (IDSA)/American Thoracic Society (ATS) recommend a respiratory fluoroquinolone or beta-lactam plus macrolide as first-line antibiotics for adults hospitalized with CAP. Few studies have assessed guideline-concordant antibiotic use for patients hospitalized with CAP after the 2007 IDSA/ATS guidelines. We examine antibiotics prescribed and associated factors in adults hospitalized with CAP. Methods From January 2010 to June 2012, adults hospitalized with clinical and radiographic CAP were enrolled in a prospective Etiology of Pneumonia in the Community study across 5 US hospitals. Patients were interviewed using a standardized questionnaire, and medical charts were reviewed. Antibiotics prescribed were classified according to defined nonrecommended CAP antibiotics. We assessed factors associated with nonrecommended CAP antibiotics using logistic regression. Results Among enrollees, 1843 of 1874 (98%) ward and 440 of 446 (99%) ICU patients received ≥1 antibiotic ≤24 hours after admission. Ward patients were prescribed a respiratory fluoroquinolone alone (n = 613; 33%), or beta-lactam plus macrolide (n = 365; 19%), beta-lactam alone (n = 240; 13%), among other antibiotics, including vancomycin (n = 235; 13%) or piperacillin/tazobactam (n = 157; 8%) ≤24 hours after admission. Ward patients with known risk for healthcare-associated pneumonia (HCAP), recent outpatient antibiotic use, and in-hospital antibiotic use <6 hours after admission were significantly more likely to receive nonrecommended CAP antibiotics. Conclusions Although more than half of ward patients received antibiotics concordant with IDSA/ATS guidelines, a number received nonrecommended CAP antibiotics, including vancomycin and piperacillin/tazobactam; risk factors for HCAP, recent outpatient antibiotic, and rapid inpatient antibiotic use contributed to this. This hypothesis-generating descriptive epidemiology analysis could help inform antibiotic stewardship efforts, reinforces the need to harmonize guidelines for CAP and HCAP, and highlights the need for improved diagnostics to better equip clinicians.

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