European Respiratory Society Annual Congress 2013 11 th September 2013 Catriona Rother Healthcare...
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E u r o p e a n R e s p i r a t o r y S o c i e t yA n n u a l C o n g r e s s 2 0 1 3
1 1 t h S e p t e m b e r 2 0 1 3C a t r i o n a R o t h e r
Healthcare associated pneumonia does not accurately identify potentially resistant pathogens: a
systematic review and meta-analysis.
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Healthcare associated pneumonia (HCAP)
• Pneumonia diagnosed in outpatients with regular healthcare contacts
Criteria for HCAP (ATS/IDSA 2005 guidelines). Any one of the following:
Resident of a nursing home or extended care facility.
Chronic dialysis within preceding 30 days.
Home infusion therapy (including antibiotics).
Home wound care.
Hospitalisation for 2 or more days in the preceding 90 days.
Family member with multi-drug resistant pathogen.
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Research Aim
• To determine the reliability of HCAP to predict potentially resistant pathogens.
MRSAP. aeruginosa
Gram negative Enterobacteriaceae
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Research Methods
Systematic review + meta-analysis Studies comparing the frequency of potentially resistant pathogens
in HCAP and CAP populations
24 studies: 22,456 patients
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1) Comparison of microbiology in HCAP vs. CAP
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Comparison of microbiology
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Comparison of microbiology
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Comparison of microbiology
Similar results when limited to prospective studies.
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Comparison of microbiology
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2) Quality of HCAP studies
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2) Quality of HCAP studies
Poor overall
Analysis for sources of bias: Variable definition of HCAP Frequency of testing for microorganisms Publication bias
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Publication bias
MRSA
P. aeruginosa
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3) Ability of HCAP definition to predict potentially resistant organisms
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Predictive accuracy of HCAP
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Predictive accuracy of HCAP
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Predictive accuracy of HCAP
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Predictive accuracy of HCAP
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Number needed to treat
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Number needed to treat
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4) Clinical outcomes in HCAP vs. CAP
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Mortality in HCAP vs. CAP
Lower risk Higher risk
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Mortality in HCAP vs. CAP
Adjusted for confounders
Lower risk with HCAP Higher risk with HCAP
No clear increased risk of mortality in HCAP.
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Conclusions
HCAP concept is a poor discriminator of patients at risk of potentially resistant pathogens.
Excess mortality in HCAP not due to increased frequency of resistant microorganisms.
HCAP studies Poor quality studies Heterogenous study methods Publication bias
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A c k n o w l e d g e m e n t s :D r J a m e s D C h a l m e r s
P r o fe s s o r D r S a nti a g o Ew i gD r Wa l e e d S a l i h
Thanks for listening…