Repository logo
 
Publication

Nursing Home-Acquired Pneumonia Presenting at the Emergency Department

2016-03-07Journal article Open access
Simple item page
dc.contributor.authorPereira, R
dc.contributor.authorOliveira, S
dc.contributor.authorAlmeida, A
dc.date.accessioned2016-03-21T12:18:37Z
dc.date.available2016-03-21T12:18:37Z
dc.date.issued2016-03-07
dc.description.abstractNursing home-acquired pneumonia (NHAP) is one of the most common infections arising amongst nursing home residents, and its incidence is expected to increase as population ages. The NHAP recommendation for empiric broad-spectrum antibiotic therapy, arising from the concept of healthcare-associated pneumonia, has been challenged by recent studies reporting low rates of multidrug-resistant (MDR) bacteria. This single center study analyzes the results of NHAP patients admitted through the Emergency Department (ED) at a tertiary center during the year 2010. There were 116 cases, male gender corresponded to 34.5 % of patients and median age was 84 years old (IQR 77-90). Comorbidities were present in 69.8 % of cases and 48.3 % of patients had used healthcare services during the previous 90 days. In-hospital mortality rate was 46.6 % and median length-of-stay was 9 days. Severity assessment at the Emergency Department provided CURB65 index score and respective mortality (%) results: zero: n = 0; one: n = 7 (0 %); two: n = 18 (38.9 %); three: n = 26 (38.5 %); four: n = 30 (53.3 %); and five; n = 22 (68.2 %); and sepsis n = 50 (34.0 %), severe sepsis n = 43 (48.8 %) and septic shock n = 22 (72.7 %). Significant risk factors for in-hospital mortality in multivariate analysis were polypnea (p = 0.001), age ≥ 75 years (p = 0.02), and severe sepsis or shock (p = 0.03) at the ED. Microbiological testing in 78.4 % of cases was positive in 15.4 % (n = 15): methicillin-resistant Staphylococcus aureus (26.7 %), Pseudomonas aeruginosa (20.0 %), S. pneumoniae (13.3 %), Escherichia coli (13.3 %), others (26.7 %); the rate of MDR bacteria was 53.3 %. This study reveals high rates of mortality and MDR bacteria among NHAP hospital admissions supporting the use of empirical broad-spectrum antibiotic therapy in these patients.pt_PT
dc.identifier.citationIntern Emerg Med. 2016 Oct;11(7):999-1004pt_PT
dc.identifier.doi10.1007/s11739-016-1412-zpt_PT
dc.identifier.urihttp://hdl.handle.net/10400.17/2442
dc.language.isoengpt_PT
dc.peerreviewedyespt_PT
dc.publisherSpringer Verlagpt_PT
dc.subjectHCC UCIpt_PT
dc.subjectHSM MEDpt_PT
dc.subjectAgedpt_PT
dc.subjectAnti-Bacterial Agents/pharmacologypt_PT
dc.subjectAged, 80 and overpt_PT
dc.subjectAnti-Bacterial Agents/therapeutic usept_PT
dc.subjectCohort Studiespt_PT
dc.subjectCommunity-Acquired Infections/epidemiologypt_PT
dc.subjectCommunity-Acquired Infections/mortality
dc.subjectEmergency Service, Hospital/organization & administration
dc.subjectEmergency Service, Hospital/statistics & numerical data
dc.subjectHospital Mortality
dc.subjectLogistic Models
dc.subjectMethicillin-Resistant Staphylococcus aureus/pathogenicity
dc.subjectNursing Homes/organization & administration
dc.subjectNursing Homes/statistics & numerical data
dc.subjectPneumonia/epidemiology
dc.subjectPneumonia/microbiology
dc.subjectPortugal/epidemiology
dc.subjectRetrospective Studies
dc.subjectRisk Factors
dc.subjectSurvival Analysis
dc.subjectTreatment Outcome
dc.titleNursing Home-Acquired Pneumonia Presenting at the Emergency Departmentpt_PT
dc.typejournal article
dspace.entity.typePublication
oaire.citation.titleInternal and Emergency Medicinept_PT
rcaap.rightsopenAccesspt_PT
rcaap.typearticlept_PT

Files

Original bundle
Now showing 1 - 1 of 1
Thumbnail Image
Name:
IEM 2016.pdf
Size:
429.72 KB
Format:
Adobe Portable Document Format
Download
License bundle
Now showing 1 - 1 of 1
No Thumbnail Available
Name:
license.txt
Size:
1.71 KB
Format:
Item-specific license agreed upon to submission
Description:
Download

Collections

UCI - Artigos
MED - Artigos