Increased Long-Term Mortality in Patients Admitted to the Intensive Care Unit with Health-Care Associated Pneumonia

The American Thoracic Society (ATS) and the Infectious Diseases Society of America (IDSA) developed and periodically update guidelines for the diagnosis and management of community-acquired and nosocomial pneumonia based on the patient-care setting in which pneumonia evolved. ATS/IDSA provides guidelines for empiric antibiotic choices based on the category of pneumonia that is diagnosed. Pneumonia is a significant cause of mortality in the United States and when combined with influenza ranks as the eighth leading cause of death nationwide yet little is known about the mortality of critically ill patients with pneumonia that require admission to a medical intensive care unit (ICU). Our findings suggest that older age, higher severity of illness at ICU admission, and chronic comorbid illnesses are the main contributors to long-term mortality from pneumonia requiring ICU admission. In this cohort, we found an independent association between increased mortality and admission from the general hospital ward rather than directly from the emergency department. Our study did not demonstrate that initial guideline-based antibiotic therapy was associated with a reduction in short-term mortality; however, it did demonstrate a high prevalence of resistant pathogens in HCAP/HAP patients, which reflects ATS/IDSA guideline expectations