Comparison of severe healthcare-associated pneumonia with severe community-acquired pneumonia.

Background: We compared the demographic characteristics and outcomes of patients with severe healthcare-associated pneumonia (HCAP) to those with severe community-acquired pneumonia (CAP).

Methods: This was a retrospective study of prospectively collected data from all consecutive patients with severe pneumonia who were admitted to the hospital through the emergency department between January 2008 and December 2010.

Results: During the study period, 247 patients had severe pneumonia; of these, 107 had severe CAP and 140 had severe HCAP. There was no significant difference in demographic characteristics between the two groups, except for comorbidities. Although the incidence of potentially drug-resistant pathogens was higher in patients with severe HCAP than in those with severe CAP (34 vs. 6 %, P = 0.004), there was no statistically significant difference in the rate of inappropriate antibiotic treatment (16 vs. 3 %, P = 0.143). Finally, clinical outcomes, such as intensive care unit admission, length of hospital stay, and in-hospital mortality, were not different between the two groups. In a multiple logistic regression analysis, a higher PSI score (adjusted OR 1.01; 95 % CI 1.00-1.02; P = 0.024) and the need for mechanical ventilation (adjusted OR 2.62; 95 % CI 1.37-5.00; P = 0.004) were independently associated with in-hospital mortality. However, the type of pneumonia was not associated with in-hospital mortality after adjusting for potential confounding factors.

Conclusions: The severity of illness rather than the type of pneumonia might be associated with in-hospital mortality in patients with severe pneumonia.