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Nursing home-acquired pneumonia: a 10 year single-centre experience
  1. E Polverino1,
  2. P Dambrava1,
  3. C Cillóniz1,
  4. V Balasso2,
  5. M A Marcos3,
  6. C Esquinas1,
  7. J Mensa2,
  8. S Ewig4,
  9. A Torres1
  1. 1Respiratory Department, Hospital Clinic-IDIBAPS, Barcelona, Spain
  2. 2Servei de Malalties Infeccioses, Hospital Clínic, Barcelona, Spain
  3. 3Servei de Microbiología, Hospital Clínic, Barcelona, Spain
  4. 4Thoraxzentrum Ruhrgebiet Kliniken für Pneumologie und Infektiologie Ev. Krankenhaus Herne und Augusta-Kranken-Anstalt, Bochum, Germany
  1. Correspondence to Professor Antoni Torres, Institut Clínic de Pneumologia i Cirurgia Toràcica, Hospital Clinic, Villarroel 170, E-8036 Barcelona, Spain; atorres{at}


Background Pneumonia among nursing home (NH) residents has increased considerably in recent years, but it remains unclear whether it should be considered as community-acquired pneumonia (CAP) or a new category of infection.

Methods 150 consecutive cases of NH-acquired pneumonia (NHAP) (from 1 February 1997 to 1 July 2007) were analysed.

Results Patients (median age, 82 years; range, 77–87 years) showed numerous co-morbidities, (neurological, 55%; pulmonary, 38%; cardiac, 35%) and severe disability for daily activities (partial, 32%; total, 31%). Cases of NHAP were mainly classified as mild to moderate according to the CRB-65 score (CRB-65 classes 0–1 and 2, 41% each). In-hospital and 30-day mortality were 8.7% and 20%, respectively. Aetiology was defined in 57 cases (38%). The most common isolates were Streptococcus pneumoniae (58%), Enterobacteriaceae (Gram-negative bacteria (GNB)) (9%), atypical bacteria (7%), respiratory viruses (5%), methicillin-resistant Staphylococcus aureus (MRSA) (5%) and Legionella pneumophila (5%). The most frequent causes of treatment inadequacy were use of β-lactams alone (25%) and lack of aspiration assessment (15%). Prognostic factors of 1-month mortality were neurological comorbidities (OR 4.5; 95% CI 1.3 to 15.7; p=0.020), septic shock (OR 6.6; 95% CI 1.3 to 34.0; p=0.025), pleural effusion (OR 3.6; 95% CI 1.1 to 11.7; p=0.036) and isolation of GNB or MRSA (OR 16.4; 95% CI 2.1 to 128.9; p=0.008).

Conclusions The patients show clinical characteristics (eg, age and co-morbidities) comparable with those with hospital-acquired pneumonia. However, microbiological and mortality data of patients with NHAP are more similar to the data of those with CAP. Isolation of GNB or MRSA was associated with increased mortality risk. CAP empirical antibiotic coverage is still indicated in NHAP, although specific risk factors for multidrug-resistant infections should be assessed on an individual basis.

  • Health care-associated pneumonia
  • microbial aetiology of pneumonia
  • nursing home-acquired pneumonia
  • pneumonia
  • respiratory infection

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  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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