1194 infection control & hospital epidemiology october 2015, vol. 36, no. 10
table 3. Outcomes Outcome
Hospital mortality, no. (%)
Hospital length of stay, days, all subjects Mean±SD
Median (interquartile range)
ICU duration, days Mean±SD
Median (interquartile range)
Duration of mechanical ventilation, days Mean±SD
Median (interquartile range) 30-day hospital readmission among hospital survivors, no. (%)
Community-onset pneumonia (n=241)
59 (24.5%) 42.4±52.4
25 (13.3-53.0) 13.6±17.9
7.8 (3.8–17.7) 12.3±14.6
8.7 (3.5–15.2) 39/182 (21.4%)
NOTE. ICU, intensive care unit. aP<.005 comparing hospital-acquired pneumonia and community-onset pneumonia. bP<.005 comparing ventilator-associated pneumonia and community-onset pneumonia. cP<.05 comparing ventilator-associated pneumonia and hospital-acquired pneumonia.
Hospital-acquired pneumonia (n=162)
65 (40.1%)a 31.9±30.1
24.5 (12.0-41.0) 19.9±19.0a
13.1 (6.9–24.7) 23.2±34.3a
11.1 (4.8–27.2) 27/97 (28.4%)
Ventilator-associated pneumonia (n=339)
142 (41.9%)b 40.1±40.7c
27.5 (14.8-53.3) 29.6±25.7b,c
21.2 (13.9–35.5) 27.1±24.2b,c
20.9 (11.7–34.2) 52/197 (26.4%)
table 4. Independent Predictors of Mortality Variable
Inappropriate initial antibiotics Vasopressor administration
Charlson comorbidity score (increasing increments of 1) Mechanical ventilation Multidrug-resistant isolate
Age (increasing increments of 1) Bacteremia
ICU admission 2.88 1.78–4.68 .029
NOTE. Factors excluded from the model for collinearity: aminoglycoside resistance, carbapenem resistance, cephalosporin resistance, fluoroquinolone resistance, penicillin-beta-lactamase inhibitor resistance (collinear with multidrug-resistant isolate). Variables included but not
retained in the model at the P<.05 in addition to those shown: corticosteroids for the ventilator-associated pneumonia analysis. Hosmer- Lemeshow/ area under the receiver operating curve: community-onset pneumonia, 0.452/0.642; hospital-acquired pneumonia, 0.866/0.679; ventilator-associated pneumonia, 0.698/0.620. AOR, adjusted odds ratio; ICU, intensive care unit.
Among patients with COP, severity of illness markers including the need for mechanical ventilation and intensive care predicted death. For the HAP cohort, infection with an MDR isolate was found to be the most important predictor of outcome. Patients with VAP had both severity of illness markers (need for vaso- pressors, bacteremia, 1-point increments in the Charlson comorbidity score) and IIAT identified as risk factors for death. Interestingly, the rates of antibiotic resistance, multidrug resis- tance, and inappropriate therapy were similar for COP, HAP, and VAP, suggesting that a similar pathogen phenotype was responsible for infection regardless of pneumonia classification. Wealso found thatMDRstatus was an important risk factor for IIAT among patients with COP and HAP. Kollef et al2 previously examined a large US pneumonia database and showed that mortality rates associated with
healthcare-associated pneumonia (HCAP) andHAP were both significantly higher than that for community-acquired pneumonia and lower than that for VAP. Similarly, hospital length of stay and hospitalization charges varied significantly with pneumonia category in order of ascending values for community-acquired pneumonia, HCAP, HAP, and VAP. These findings were confirmed in a subsequent single-center study from the United States.20 However, several authors have criticized the use of the term HCAP, suggesting that it could result in the needless administration of broad-spectrum antibiotics to individuals with COP not infected with antibiotic-resistant pathogens.21,22 An alternative approach for classifying patients with COP is to identify the number of risk factors for MDR infection they have in order to better direct the use of broad-spectrum antibiotics.23 Our study found that
3.27 1.85–5.76 .037 5.50 3.56–8.51 <.001
1.02 3.72
1.01–1.03 2.49–5.55
.008 .001
Community-onset pneumonia Hospital-acquired pneumonia Ventilator-associated pneumonia AOR 95% CI
P value AOR 95% CI
P value AOR 95% CI 1.40–2.45
1.86 2.04 1.14
1.54–2.70 1.08–1.20
P value .026
.011 .018
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