[Hospitalized nursing home-acquired pneumonia--comparison with community-acquired pneumonia in older adults].

ABSTRACT

Nursing home-acquired pneumonia (NHAP) is a frequent cause of hospital admission and death among residents of long-term care facilities. We studied consecutive patients with NHAP who were admitted to our 358-bed acute care hospital from 2004 to 2007. Patients with NHAP (n = 147) were significantly older (85.8 +/- 8.0 years vs. 80.2 +/- 8.2 years); predominantly female (57.1% vs. 41.5%); had higher severity (the 2005 Japanese Respiratory Society guidelines A-DROP score 2.5 +/- 1.1 vs. 2.1 +/- 1.2) and a higher mortality (10.4% vs. 5.8%); had a longer median length of hospital stay (17 days vs. 15 days) than elderly patients with community-acquired pneumonia (n = 545). Cerebrovascular disorders (31.3% vs. 14.1%), dementia (59.2% vs. 22.9%) and feeding tube placement (19.0% vs. 6.4%), which were associated with aspiration, were more common and bronchial asthma (0.7% vs. 8.8%) and COPD (4.1% vs. 19.8%) less common among those with NHAP. Although Methicillin-resistant Staphylococcus aureus (MRSA) was more frequently isolated from the sputa of the NHAP group (23.1% vs. 9.4%), Streptococcus pneumoniae was the most important causative agent by microbial investigations, including blood culture and urinary antigen testing in addition to sputum examination.