Healthcare-associated pneumonia among hospitalized patients in a Korean tertiary hospital

We conducted a retrospective, observational study of 527 patients with HCAP or CAP who were hospitalized at Severance Hospital in South Korea between January and December 2008.Of these patients, 231 (43.8%) had HCAP, and 296 (56.2%) had CAP. Potentially drug-resistant (PDR) bacteria were more frequently isolated in HCAP than CAP (12.6% vs. 4.7%; P = 0.001), especially in the low-risk group of the PSI classes (41.2% vs. 13.9%; P = 0.027). In-hospital mortality was higher for HCAP than CAP patients (28.1% vs. 10.8%, P < 0.001), especially in the low-risk group of PSI classes (16.4% vs. 3.1%; P = 0.001). Moreover, tube feeding and prior hospitalization with antibiotic treatment within 90 days of pneumonia onset were significant risk factors for PDR pathogens, with odds ratios of 14.94 (95% CI 4.62-48.31; P < 0.001) and 2.68 (95% CI 1.32-5.46; P = 0.007), respectively.For HCAP patients with different backgrounds, various pathogens and antibiotic resistance of should be considered, and careful selection of patients requiring broad-spectrum antibiotics is important when physicians start initial antibiotic treatments.Pneumonia has traditionally been classified as either community- or hospital- acquired, based on the patient's location when the infection was acquired. However, an increasing number of out-of-hospital services, such as nursing homes, outpatient parenteral therapy, hemodialysis clinics, and domiciliary care, create a class of patients who do not truly reside in the "community."Previous studies have suggested that nursing home-acquired pneumonia or pneumonia in long-term care facilities should be considered separately from community-acquired pneumonia (CAP) [1-3]. Infections occurring in these patients show a more similar epidemiological pattern to hospital-acquired pneumonia (HAP) than to CAP [1-3]. Different epidemiological patterns from CAP require a distinct targeted therapeutic approach, especially against multidrug-resistant pathogens [4,5]. Thus, since 2