The purpose of this study was to investigate the clinical aspects of patients satisfying the Infectious Disease Society of America/American Thoracic Society (IDSA/ATS) minor severity criteria, focusing on their treatment response to empirical antibiotics. In total, 381 community-acquired pneumonia (CAP) patients who did not require mechanical ventilation or vasopressors at admission were enrolled, and 50 (13.1%) satisfied the minor severity criteria (i.e. , minor severe CAP [minor-SCAP]). The rates of new complication events and clinical treatment failure were significantly higher in the minor-SCAP group than in the control group (30.0% vs 2.1%, P < 0.001, and 42.0% vs 10.6%, P < 0.001, respectively), and the time to reach clinical stability was longer in the minor-SCAP group (8 days vs 3 days, P < 0.001). In a multivariate model, minor severity criteria (> or = 3) were significantly associated with treatment failure (odds ratio, 2.838; 95% confidence interval, 1.216 to 6.626), and for predicting treatment failure the value of the area under the receiver operating characteristic curve for minor criteria was 0.731, similar to other established scoring methods. The IDSA/ATS minor severity criteria can predict delayed treatment response and clinical treatment failure.
Adult ; Aged ; Anti-Bacterial Agents/therapeutic use ; Area Under Curve ; Community-Acquired Infections/*diagnosis/drug therapy/mortality ; Female ; Hospital Mortality ; Humans ; Intensive Care Units ; Kaplan-Meier Estimate ; Length of Stay ; Male ; Middle Aged ; Odds Ratio ; Pneumonia/*diagnosis/drug therapy/mortality ; Predictive Value of Tests ; ROC Curve ; *Severity of Illness Index

BACKGROUND/AIMS: Nursing home-acquired pneumonia (NHAP) is included under healthcare-associated pneumonia. However, the optimal treatment strategy for NHAP has been controversial in several studies. We evaluated the clinical features of NHAP compared to community-acquired pneumonia (CAP) in elderly patients admitted with pneumonia. METHODS: This was a retrospective study in elderly patients aged > or = 65 years with NHAP or CAP who were hospitalized at Jeju National University Hospital between January 2012 and April 2013. RESULTS: A total of 209 patients were enrolled, and 58 (27.7%) had NHAP. The patients with NHAP were older, had more frequent central nervous system disorders, and showed worse clinical parameters. Potential drug-resistant pathogens were more frequently detected in the NHAP group (22.4% vs. 9.9%, p = 0.018), and the incidences of Pseudomonas aeruginosa and methicillin-resistant Staphylococcus aureus were 8.6% and 10.3%, respectively. In-hospital mortality occurred in 13 patients (22.4%) with NHAP and 17 patients (11.2%) with CAP (p = 0.039). In multivariate analyses, only higher pneumonia severity index (PSI) score was associated with increased mortality (p < 0.001), and the PSI score was higher in the NHAP group than that in the CAP group. CONCLUSIONS: Elderly patients admitted with NHAP showed more severe pneumonia at onset, higher rates of potentially drug-resistant pathogens, and worse clinical outcomes than those with CAP. However, higher in-hospital mortality in those with NHAP seemed to be related to the PSI score reflecting host factors and severity of pneumonia rather than the type of pneumonia or the presence of drug-resistant pathogens.
Age Factors ; Aged ; Aged, 80 and over ; Anti-Bacterial Agents/*therapeutic use ; Chi-Square Distribution ; Community-Acquired Infections/diagnosis/microbiology/mortality/*therapy ; Cross Infection/diagnosis/microbiology/mortality/*therapy ; Drug Resistance, Bacterial ; Female ; *Homes for the Aged ; Hospital Mortality ; *Hospitals, Teaching ; Humans ; Logistic Models ; Male ; Microbial Sensitivity Tests ; Multivariate Analysis ; *Nursing Homes ; Odds Ratio ; *Patient Admission ; Pneumonia, Bacterial/diagnosis/microbiology/mortality/*therapy ; Republic of Korea ; Retrospective Studies ; Risk Factors ; Severity of Illness Index ; Treatment Outcome