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Original article
Nursing-home-acquired pneumonia in Germany: an 8-year prospective multicentre study
  1. Santiago Ewig1,
  2. Benjamin Klapdor1,
  3. Mathias W Pletz2,
  4. Gernot Rohde3,
  5. Hartwig Schütte4,
  6. Tom Schaberg5,
  7. Torsten T Bauer6,
  8. Tobias Welte7,
  9. for the CAPNETZ study group
  1. 1Thoraxzentrum Ruhrgebiet, Department of Respiratory and Infectious Diseases, EVK Herne and Augusta-Kranken-Anstalt Bochum, Germany
  2. 2Division of Gastroenterology, Hepatology and Infectious Diseases, Jena University Hospital, Jena, Germany
  3. 3Department of Respiratory Medicine, Maastricht University Medical Centre, The Netherlands
  4. 4Medical Clinic, Infectious Diseases and Respiratory Medicine, Charité – Berlin University, Berlin, Germany
  5. 5Diakoniekrankenhaus, Respiratory Clinic Unterstedt, Rotenburg an der Wümme, Germany
  6. 6Lungenklinik Heckeshorn, Helios Klinikum Emil von Behring, Berlin, Germany
  7. 7Department of Respiratory Medicine, Hannover University, Hannover, Germany
  1. Correspondence to Prof Santiago Ewig, Thoraxzentrum Ruhrgebiet, Kliniken für Pneumologie und Infektiologie, EVK Herne und Augusta-Kranken-Anstalt Bochum, Bergstrasse 26, 44791 Bochum, Germany; sewig{at}


Objective To determine differences in aetiologies, initial antimicrobial treatment choices and outcomes in patients with nursing-home-acquired pneumonia (NHAP) compared with patients with community-acquired pneumonia (CAP), which is a controversial issue.

Methods Data from the prospective multicentre Competence Network for Community-acquired pneumonia (CAPNETZ) database were analysed for hospitalised patients aged ≥65 years with CAP or NHAP. Potential differences in baseline characteristics, comorbidities, physical examination findings, severity at presentation, initial laboratory investigations, blood gases, microbial investigations, aetiologies, antimicrobial treatment and outcomes were determined between the two groups.

Results Patients with NHAP presented with more severe pneumonia as assessed by CRB-65 (confusion, respiratory rate, blood pressure, 65 years and older) score than patients with CAP but received the same frequency of mechanical ventilation and less antimicrobial combination treatment. There were no clinically relevant differences in aetiology, with Streptococcus pneumoniae the most important pathogen in both groups, and potential multidrug-resistant pathogens were very rare (<5%). Only Staphylococcus aureus was more frequent in the NHAP group (n=12, 2.3% of the total population, 3.1% of those with microbial sampling compared with 0.7% and 0.8% in the CAP group, respectively). Short-term and long-term mortality in the NHAP group was higher than in the CAP group for patients aged ≥65 years (26.6% vs 7.2% and 43.8% vs 14.6%, respectively). However, there was no association between excess mortality and potential multidrug-resistant pathogens.

Conclusions Excess mortality in patients with NHAP cannot be attributed to a different microbial pattern but appears to result from increased comorbidities, and consequently, pneumonia is frequently considered and managed as a terminal event.

  • Aspergillus lung disease
  • atypical mycobacterial infection
  • bacterial infection
  • bronchiectasis
  • bronchoscopy
  • clinical epidemiology
  • COPD exacerbations
  • empyema
  • pleural disease
  • pneumonia
  • respiratory infection
  • tuberculosis
  • viral infection
  • airway epithelium
  • COPD epidemiology
  • innate immunity
  • oxidative stress
  • tuberculosis
  • asbestos induced lung disease
  • ARDS
  • asthma pharmacology
  • bronchiectasis
  • cystic fibrosis
  • lung transplantation
  • non-invasive ventilation

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  • Funding Bundesministerium für Bildung und Forschung (BMBF).

  • Competing interests None.

  • Ethics approval Central and local ethical committees (Ulm and local CAPNETZ centres).

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

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