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Incidence and risk factors of non–device-associated pneumonia in an acute-care hospital

Published online by Cambridge University Press:  29 October 2019

Paula D. Strassle Open the ORCID record for Paula D. Strassle [Opens in a new window] ,
Emily E. Sickbert-Bennett ,
Michael Klompas ,
Jennifer L. Lund ,
Paul W. Stewart ,
Ashley H. Marx ,
Lauren M. DiBiase  and
David J. Weber
Paula D. Strassle*
Affiliation:
Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
Emily E. Sickbert-Bennett
Affiliation:
Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina Department of Hospital Epidemiology, University of North Carolina Medical Center, Chapel Hill, North Carolina
Michael Klompas
Affiliation:
Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
Jennifer L. Lund
Affiliation:
Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
Paul W. Stewart
Affiliation:
Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
Ashley H. Marx
Affiliation:
Department of Pharmacy, University of North Carolina Medical Center, Chapel Hill, North Carolina
Lauren M. DiBiase
Affiliation:
Department of Hospital Epidemiology, University of North Carolina Medical Center, Chapel Hill, North Carolina
David J. Weber
Affiliation:
Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina Department of Hospital Epidemiology, University of North Carolina Medical Center, Chapel Hill, North Carolina
*
Author for correspondence: Paula D. Strassle, Email: paula_strassle@med.unc.edu
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Abstract

Objective:

To update current estimates of non–device-associated pneumonia (ND pneumonia) rates and their frequency relative to ventilator associated pneumonia (VAP), and identify risk factors for ND pneumonia.

Design:

Cohort study.

Setting:

Academic teaching hospital.

Patients:

All adult hospitalizations between 2013 and 2017 were included. Pneumonia (device associated and non–device associated) were captured through comprehensive, hospital-wide active surveillance using CDC definitions and methodology.

Results:

From 2013 to 2017, there were 163,386 hospitalizations (97,485 unique patients) and 771 pneumonia cases (520 ND pneumonia and 191 VAP). The rate of ND pneumonia remained stable, with 4.15 and 4.54 ND pneumonia cases per 10,000 hospitalization days in 2013 and 2017 respectively (P = .65). In 2017, 74% of pneumonia cases were ND pneumonia. Male sex and increasing age we both associated with increased risk of ND pneumonia. Additionally, patients with chronic bronchitis or emphysema (hazard ratio [HR], 2.07; 95% confidence interval [CI], 1.40–3.06), congestive heart failure (HR, 1.48; 95% CI, 1.07–2.05), or paralysis (HR, 1.72; 95% CI, 1.09–2.73) were also at increased risk, as were those who were immunosuppressed (HR, 1.54; 95% CI, 1.18–2.00) or in the ICU (HR, 1.49; 95% CI, 1.06–2.09). We did not detect a change in ND pneumonia risk with use of chlorhexidine mouthwash, total parenteral nutrition, all medications of interest, and prior ventilation.

Conclusion:

The incidence rate of ND pneumonia did not change from 2013 to 2017, and 3 of 4 nosocomial pneumonia cases were non–device associated. Hospital infection prevention programs should consider expanding the scope of surveillance to include non-ventilated patients. Future research should continue to look for modifiable risk factors and should assess potential prevention strategies.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 41 , Issue 1 , January 2020 , pp. 73 - 79
Copyright
© 2019 by The Society for Healthcare Epidemiology of America. All rights reserved. 

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