American Journal of Epidemiology Vol. 129, No. 6: 1258-1267
Copyright © 1989 by The Johns Hopkins University School of Hygiene and Public Health
research-article |
HOSPITAL-ACQUIRED PNEUMONIA
ATTRIBUTABLE MORTALITY AND MORBIDITY
1Hospital Epidemiology, Chang Gung Memorial Hospital Taipei, Taiwan
22 University ofVirginia Medical Center Charlottesville, VA
3Department of Preventive Medicine, University of Iowa College of Medicine Iowa City, IA
4Department of Internal Medicine, Division of Clinical Epidemiology, University of Iowa College of Medicine Iowa City, IA
Reprint requests to Dr. Richard P. Wenzel, C 41 GH, University of Iowa Hospitals and Clinics, Iowa City, IA 52242
A total of 1,001 consecutIve episodes of nosocomlal pneumonia in 901 patients was identified by routine surveillance at the University of Virginia Medical Center between 1979 and 1983 (8.6 episodes/1,000 admissions). When only initial episodes were examined, 890 patients comprised the study sample. The overall case fatality rate was 30%. Stepwlse logistic regression Indicated that time from admission to pneumonia (p = 0.0006), age (p <0.0001), prior use of mechanical ventilation (p = 0.0032), and neoplastic disease (p = 0.0062) were associated with mortality. Multiple regression analysis indicated that the factors associated with increased length of hospitalization included posttracheostomy status (p = 0.0001), prior mechanical ventilation (p = 0.0001), immunosuppressive or leuko penic status (p = 0.0009), nasogastric intubation (p = 0.0003), and prior bacte remia (p = 0.0 127). A sampled, individually matched cohort study (n = 74 pairs) was conducted to determine the proportion of mortality in cases that was attributable to infections (33%) and to determine excess hospital stay (seven days) among the patients with nosocomial pneumonia. Excess stay was statisti cally significant (p < 0.0001), but proportional mortality was only marginally significant (p = 0.0892). Our findings suggest that nosocomial pneumonia ac counts for approximately 33% of the crude mortality and contributes significantly to the economic burden associated with prolonged hospitalization.
morbidity; mortality; pneumonia
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