In the Journals

5-year study shows predominance of non-device-associated pneumonia

Paula D. Strassle, PhD, MSPH
Paula D. Strassle

Among more than 160,000 patients admitted to University of North Carolina hospitals during a recent 5-year period, non-device-associated, or ND, pneumonia was implicated in three of every four nosocomial pneumonia cases, with more than 60% occurring outside the ICU, indicating a possible need to expand infection prevention programs to include non-ventilated patients, researchers said.

“Currently, the CDC supports the reporting of ventilator-associated events, which include ventilator-associated pneumonia,” Paula D. Strassle, PhD, MSPH, assistant professor of surgery at the University of North Carolina at Chapel Hill, told Infectious Disease News. “Non-device-associated pneumonia is not reportable, and because of that — and limited resources — many hospitals do not capture ND pneumonia rates at their institutions.”

The researchers included all hospitalizations of adults aged 18 years or older from January 2013 through December 2017. During that period, there were 163,386 hospitalizations among 97,485 unique patients. The researchers detected 771 pneumonia cases, of which 520 were classified as ND pneumonia and 191 as ventilator-associated pneumonia (VAP).

In 2013, the researchers recorded 4.15 ND pneumonia cases per 10,000 hospitalization days compared with 4.54 in 2017 (P = .65), demonstrating a stable rate of ND pneumonia cases throughout the study period. In 2017, ND pneumonia accounted for 74% of pneumonia cases.

Strassle noted that male sex, older age, chronic bronchitis or emphysema (HR = 2.07; 95% CI, 1.40-3.06), congestive heart failure (HR = 1.48; 95% CI, 1.07-2.05), paralysis (HR = 1.72; 95% CI, 1.09-2.73), immunosuppression (HR = 1.54; 95% CI, 1.18-2.00) and being admitted to the ICU (HR = 1.49; 95% CI, 1.06-2.09) were associated with a higher risk for infection.

“Hospital infection prevention programs may need to expand the scope of their programs to include nonventilated patients, as current practices miss the majority of health care-associated pneumonia,” Strassle said.

According to the researchers, chlorhexidine mouthwash, total parenteral nutrition, inpatient medications and prior ventilation did not change the risk for ND pneumonia.

Strassle highlighted the need for surveillance measures.

“Without surveillance, hospitals cannot know the magnitude of the problem, and prevention strategies cannot be developed or tested. However, I am also aware that it is not that simple,” she said. “I think the most important thing is to raise awareness of these infections.”

Strassle underscored the changing landscape regarding health care-associated infections (HAIs).

“While the conversation is shifting to these non-device-associated infections, historically the focus has been on device-associated HAIs for both surveillance and prevention,” she said. “And while that made sense 20 years ago, prevention efforts have changed the landscape of HAIs, and now non-device-associated infections are more common and have a larger at-risk population.” – by Marley Ghizzone

Disclosures: The authors report no relevant financial disclosures.

Paula D. Strassle, PhD, MSPH
Paula D. Strassle

Among more than 160,000 patients admitted to University of North Carolina hospitals during a recent 5-year period, non-device-associated, or ND, pneumonia was implicated in three of every four nosocomial pneumonia cases, with more than 60% occurring outside the ICU, indicating a possible need to expand infection prevention programs to include non-ventilated patients, researchers said.

“Currently, the CDC supports the reporting of ventilator-associated events, which include ventilator-associated pneumonia,” Paula D. Strassle, PhD, MSPH, assistant professor of surgery at the University of North Carolina at Chapel Hill, told Infectious Disease News. “Non-device-associated pneumonia is not reportable, and because of that — and limited resources — many hospitals do not capture ND pneumonia rates at their institutions.”

The researchers included all hospitalizations of adults aged 18 years or older from January 2013 through December 2017. During that period, there were 163,386 hospitalizations among 97,485 unique patients. The researchers detected 771 pneumonia cases, of which 520 were classified as ND pneumonia and 191 as ventilator-associated pneumonia (VAP).

In 2013, the researchers recorded 4.15 ND pneumonia cases per 10,000 hospitalization days compared with 4.54 in 2017 (P = .65), demonstrating a stable rate of ND pneumonia cases throughout the study period. In 2017, ND pneumonia accounted for 74% of pneumonia cases.

Strassle noted that male sex, older age, chronic bronchitis or emphysema (HR = 2.07; 95% CI, 1.40-3.06), congestive heart failure (HR = 1.48; 95% CI, 1.07-2.05), paralysis (HR = 1.72; 95% CI, 1.09-2.73), immunosuppression (HR = 1.54; 95% CI, 1.18-2.00) and being admitted to the ICU (HR = 1.49; 95% CI, 1.06-2.09) were associated with a higher risk for infection.

“Hospital infection prevention programs may need to expand the scope of their programs to include nonventilated patients, as current practices miss the majority of health care-associated pneumonia,” Strassle said.

According to the researchers, chlorhexidine mouthwash, total parenteral nutrition, inpatient medications and prior ventilation did not change the risk for ND pneumonia.

Strassle highlighted the need for surveillance measures.

“Without surveillance, hospitals cannot know the magnitude of the problem, and prevention strategies cannot be developed or tested. However, I am also aware that it is not that simple,” she said. “I think the most important thing is to raise awareness of these infections.”

Strassle underscored the changing landscape regarding health care-associated infections (HAIs).

“While the conversation is shifting to these non-device-associated infections, historically the focus has been on device-associated HAIs for both surveillance and prevention,” she said. “And while that made sense 20 years ago, prevention efforts have changed the landscape of HAIs, and now non-device-associated infections are more common and have a larger at-risk population.” – by Marley Ghizzone

Disclosures: The authors report no relevant financial disclosures.