Nursing Home‐Acquired Pneumonia: A Case‐Control Study

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Abstract
To determine if there are any unique features of nursing home‐acquired pneumonia we carried out a case‐control study wherein each patient admitted with nursing home‐acquired pneumonia was age‐ and sex‐matched with a patient with community‐acquired pneumonia. There were 36 men and 38 women in the nursing home group. The mean age of both groups was 74 years. The mortality rate for nursing home‐acquired pneumonia was 40.5%, whereas for community‐acquired pneumonia it was 28% (P = NS). Patients with nursing home‐acquired pneumonia had a significantly higher incidence of dementia and cerebrovascular accidents, and patients with community‐acquired pneumonia were more likely to be smokers and to have chronic obstructive pulmonary disease. Aspiration pneumonia was more common among patients with nursing home‐acquired pneumonia (P < .001), and Hemophilus influenza pneumonia more common among the patients with community‐acquired infection (P < .01). Sputum for culture could be obtained in only 31 and 39% of the patients—contributory to the high rates of pneumonia of unknown etiology 63.5 and 56.1% for the nursing home group and the control subjects, respectively. Patients with nursing home‐acquired pneumonia received cloxacillin and aminogylcosides more frequently than patients with community‐acquired pneumonia (P < .05), and patients with community‐acquired pneumonia received erythromycin more frequently than patients with nursing home‐acquired pneumonia (P < .05). Complications were common during the hospital stay of these patients—the most frequent being congestive heart failure, urinary tract infection, renal failure, and respiratory failure.

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