Clinical features and outcomes of aspiration pneumonia compared with non-aspiration pneumonia in nosocomial settings

초록

Background and Aims Aspiration pneumonia(AP) commonly develops with aging, but the clinical characteristics and outcomes are not well known. The purpose of this study is to compare the clinical features and outcomes of AP with non-AP in nosocomial settings. Methods We investigated 883 patients diagnosed with hospital-acquired pneumonia (HAP) in the general ward from the multicenter retrospective cohort study data involving 13 tertiary hospitals in Korea between January 1 and December 31, 2019. It was diagnosed as AP if there were at least one of the following risk factors; impaired swallowing,impaired consciousness, increased chance of gastric contents reaching the lung, and impaired cough reflex. Results Among 883 patients, 521 (59%) patients were diagnosed with AP. AP group was older than non-AP group with a median age of 77.0 years (IQR, 66.0-83.0 years). The chronic neurological disease was more common in AP group (43.2% vs 6.6%; p< 0.001). There were no significant differences in multi-drug resistance pathogens isolated from respiratory specimens. When comparing the appropriacy of initial empiric antibiotics, inappropriate cases were higher in AP group(39.1% vs 33.3%;p=0.018). Clinical response and microbiological response were not different between the two groups. Hospital mortality was not different between the two groups (28.6% vs 27.6%; p=0.810), but the discharge rate of survivors to home was lower in AP group (43.5% vs 84.0%; p< 0.001). Conclusion AP is associated with old age and chronic neurological disease. AP did not differ from non-AP in clinical outcomes, but the discharge rate to home was significantly lower.