Trajectories of risk after hospitalization for heart failure, acute myocardial infarction, or pneumonia: retrospective cohort studyBMJ 2015; 350 doi: https://doi.org/10.1136/bmj.h411 (Published 06 February 2015) Cite this as: BMJ 2015;350:h411
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Healthcare associated pneumonia (HCAP) and nursing and healthcare-associated pneumonia (NHCAP) are higher readmission rate and mortality than community acquired pneumonia (CAP): retrospective cohort study
Dharmarajan and coworkers have revealed that risk declines slowly for older patients after hospitalization for heart failure, acute myocardial infarction, or pneumonia and is increased for months (1). The re-admission of pneumonia after hospitalization has recently been determined as Healthcare associated pneumonia (HCAP) in USA and nursing and healthcare-associated pneumonia (NHCAP) in Japan (2,3).
Compared with CAP, HCAP and NHCAP had a higher 30-day mortality rate and longer length of hospital stay. Several investigators indicated that multidrug-resistant (MDR) pathogens were isolated more frequently in HCAP and NHCAP than in CAP (4-6). These pathogens may be related to the poor prognosis of pneumonia in older people. However, HCAP or NHCAP includes any patient who was hospitalized in an acute care hospital for two or more days within 90 days of the infection. The current study confirms that HCAP or NHCAP patients have a higher readmission rates and mortality. That is why the definition of HCAP or NHCAP itself may be a prognostic marker for older people. Therefore, the increased mortality in HCAP and NHCAP patients is the result of post-infectious state, post-hospitalized state, and patient underling disorders rather than the presence of MDR pathogens.
1) Trajectories of risk after hospitalization for heart failure, acute myocardial infarction, or pneumonia: retrospective cohort study. BMJ 2015;350:h411
2) American Thoracic Society/Infectious Society of America. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med 171: 388-416, 2005.
3) Kohno S, Imamura Y, Shindo Y, et al.. Clinical practice guidelines for nursing- and healthcare-associated pneumonia (NHCAP) [complete translation]. Respir Investig. 2013;51:103-26.
4) Micek ST, Kollef KE, Reichley RM, et al. Health care-associated pneumonia and community-acquired pneumonia: a single-center experience. Antimicrob Agents Chemother. 2007;51: 3568-3573.
5) Polverino E, Torres A, Menendez R, et al. Microbial aetiology of healthcare associated pneumonia in Spain: a prospective, multicentre, case-control study. Thorax. 2013;68:1007-14.
6) Fukuyama H, Yamashiro S, Tamaki H, Kishaba T. A prospective comparison of nursing- and healthcare-associated pneumonia (NHCAP) with community-acquired pneumonia (CAP). J Infect Chemother. 2013;19(4):719-26.
Competing interests: No competing interests