Which Nursing Home Residents With Pneumonia Are Managed On-Site and Which Are Hospitalized? Results from 2 Years' Surveillance in 14 US Homes |
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| Institution: | 1. The Cecil G. Sheps Center for Health Service Research, University of North Carolina, Chapel Hill, NC, USA;2. Schools of Social Work and Public Health, University of North Carolina, Chapel Hill, NC, USA;3. Department of Family Medicine, University of North Carolina, Chapel Hill, NC, USA;4. Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA;1. CIRO+, Department of Research & Development, Horn, the Netherlands;2. NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre, Maastricht, the Netherlands;3. Department of Respiratory Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands;4. Viscovery Software GmbH, Vienna, Austria;5. School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Centre, Maastricht, the Netherlands;6. Ludwig Boltzman Institute for Lung Health, Vienna, Austria;1. Division of Family Medicine and Geriatrics, University of Louisville, Louisville, KY, USA;2. Signature HealthCARE, Louisville, KY, USA;3. California State University Institute for Palliative Care, San Marcos, CA, USA;4. Eisenberg Village, Los Angeles Jewish Home, Reseda, CA, USA;5. Arnall Golden Gregory LLP, Atlanta, GA, USA;6. Avar Consulting, Inc. Rockville, MD, USA;1. Research Unit for General Practice, Aarhus, Denmark;2. Department of Public Health, Aarhus University, Aarhus, Denmark;3. Steno Diabetes Center Aarhus, Aarhus, Denmark;4. Department of Geriatrics, Aarhus University Hospital, Aarhus, Denmark;1. Ottawa Hospital Research Institute, Ottawa, Ontario, Canada;2. Bruyère Research Institute, Ottawa, Ontario, Canada;3. ICES uOttawa, Ottawa, Ontario, Canada;4. ICES McMaster, Hamilton, Ontario, Canada;5. Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada;6. Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada;7. Department of Medicine, McMaster University, Hamilton, Ontario, Canada;8. Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada;9. Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada;10. St. Patrick''s Home of Ottawa, Ottawa, Ontario, Canada |
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| Abstract: | ObjectivesPneumonia is a frequent cause of hospitalization among nursing home (NH) residents, but little information is available as to how clinical presentation and other characteristics relate to hospitalization, and the differential use of antimicrobials based on hospitalization status. This study examined how hospitalized and nonhospitalized NH residents with pneumonia differ.DesignData from a 2-year prospective study of residents who participated in a randomized controlled trial.Setting and ParticipantsAll residents from 14 NHs in North Carolina followed for pneumonia over a 2-year period.MethodsClinical features, antimicrobial treatment, hospitalization, and demographic data on residents with a pneumonia diagnosis were abstracted from charts; NH information was obtained from NH administrators.ResultsA total of 509 pneumonia episodes were reported for 395 unique residents; the incidence was not higher in the winter months, and 28% were hospitalized. The likelihood of hospitalization did not differ by clinical characteristics except that residents with a respiratory rate >25 breaths per minute were more likely to be hospitalized. Being on hospice odds ratio (OR) 3.3, 95% confidence interval (CI) 1.5–7.4] and not having dementia (OR 1.9, 95% CI 1.1–3.2) also related to increased likelihood of hospitalization. Fluoroquinolone (usually levofloxacin) monotherapy was the most common treatment (54%) in both settings, and ceftriaxone monotherapy varied by hospitalization status (7% of hospitalized vs 16% treated on-site). Approximately 36% of nonhospitalized residents received antimicrobials for more than 7 days.Conclusions/ImplicationsRespiratory rate is associated with hospitalization but was not documented for more than a quarter of residents, suggesting the clinical benefit of more consistently conducting this assessment. Differential hospitalization rates for persons with dementia and on hospice suggest that care is being tailored to individuals' wishes, but this assumption merits study, as does use of fluoroquinolones (due to side effects) and treatment duration (due to potential contribution to antibiotic resistance). |
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| Keywords: | Pneumonia hospitalization antimicrobial prescribing nursing homes elderly |
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