Short reportIncidence and impact of hospital-acquired pneumonia: a Portuguese nationwide four-year study
Introduction
Hospital-acquired infections, especially pneumonia (HAP), remain one of the most important challenges clinicians face in everyday work [1]. Nevertheless, the epidemiology of HAP is uncertain. Epidemiological studies focusing on HAP in non-ventilated patients suggest that the incidence may be twice as high as that of ventilator-associated pneumonia, with similar mortality rate and frequently leading to intensive care unit (ICU) admission [2,3].
There is scarce information regarding both HAP risk and incidence outside the ICU, and epidemiological data regarding HAP global incidence is clearly needed.
This study addressed the incidence of HAP at a national level. Data from four consecutive years (2014–2017) were studied to account for possible seasonal variation. We included all hospitals, both community and university, of the Portuguese mainland healthcare system. The aim was to determine the burden of HAP nationally, and to identify the subgroups at higher risk.
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Methods
The Central Administration of the Health System of the Portuguese Ministry of Health records administrative and clinical discharge data for all admissions to the 100 (77 general) National Health System hospitals in mainland Portugal. The anonymized database includes all discharge diagnoses of hospital inpatients, either dead or alive, codified according to the International Classification of Diseases, 9th Revision Clinical Modification (ICD-9-CM), until 2016, and the 10th Revision (ICD-10-CM),
Hospital-acquired pneumonia incidence
A total of 3,026,233 hospital discharges were evaluated. We identified 28,632 episodes of HAP. The overall incidence was 0.95% and this increased almost five times with age (Figure 1). The incidence of HAP per 1000 hospital-days was 1.13 (1.42 in men and 0.85 in women). Male patients represented only 42.3% of all hospital admissions but accounted for 61.9% of HAP cases (Figure 1).
Overall, HAP was strongly associated with prolonged LOS (mean 26.4 days) and with very high mortality (33.6%), both
Discussion
The incidence of HAP in mainland Portugal during a consecutive four-year period, from 2014 to 2017, was 0.95%, which corresponded to 1.13 episodes per 1000 hospital-days. Patients aged ≥65 years and male gender were significantly more prone to HAP, especially patients with an acute stroke. Hospital mortality was very high, at 33.6% overall, and increased sharply with age. Even patients without significant comorbidities had a mortality rate of roughly 30%, suggesting that attributable mortality
References (10)
- et al.
Hospital Acquired Pneumonia Prevention Initiative-2: incidence of nonventilator hospital-acquired pneumonia in the United States
Am J Infect Control
(2018) - et al.
The epidemiology of nonventilator hospital-acquired pneumonia in the United States
Am J Infect Control
(2018) - et al.
Epidemiology, treatment, and prevention of nosocomial bacterial pneumonia
J Clin Med
(2020) - et al.
The breadth of hospital-acquired pneumonia: nonventilated versus ventilated patients in Pennsylvania
Pennsylvania Patient Saf Auth
(2012) - et al.
Healthcare-associated pneumonia in acute care hospitals in European union/European economic area countries: an analysis of data from a point prevalence survey, 2011 to 2012
Eurosurveillance
(2018)