Patient selection: adult hospitalized for pneumonia
Outcome: 30-day readmission after discharge
Criteria for healthcare-associated pneumonia (HCAP) – one or more of the following:
(1) admission from a long-term care facility or nursing home
(2) inpatient hospitalization >= 48 hours during the preceding 90 days (3 months) prior to this admission
(3) exposure in the past 30 days to broad-spectrum antibiotics
(4) immunosuppression
(5) dialysis
(6) chronic wound care
Several of the criteria for HCAP are also risk factors for exposure to an antibiotic-resistant bacteria.
Criteria for immunosuppression – one or more of the following:
(1) active malignancy and undergoing chemotherapy
(2) immunosuppressant therapy (>= 10 mg prednisone or equivalent daily for >= 30 days, methotrexate, etc)
(3) AIDS
The risk of readmission is greater for HCAP than for community-acquired pneumonia (CAP), with the odds ratio 7.5.
The risk for readmission in a patient with HCAP was related to:
(1) immunosuppression
(2) recent antibiotic exposure
(3) prior hospitalization
(4) admission from a long-term care facility
