Preventability of Hospital Deaths in Patients With Non-Ventilator Hospital-Acquired Pneumonia.

Autor:	Tatara AM; Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.; Department of Bioengineering, School of Engineering and Applied Sciences, Harvard University, Cambridge, Massachusetts, USA., Apostolopoulou A; Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA., Agan AA; Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA., DelloStritto L; Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA., Rhee C; Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA.; Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA., Klompas M; Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA.; Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.
Jazyk:	angličtina
Zdroj:	Clinical infectious diseases : an official publication of the Infectious Diseases Society of America [Clin Infect Dis] 2024 Nov 22; Vol. 79 (5), pp. 1269-1276.
DOI:	10.1093/cid/ciae418
Abstrakt:	Background: Crude and adjusted mortality rates for patients with non-ventilator hospital-acquired pneumonia (NV-HAP) are among the highest of all healthcare-associated infections, leading to calls for greater prevention. Patients prone to NV-HAP, however, tend to be severely ill at baseline, making it unclear whether their high mortality rates are due to NV-HAP, their underlying conditions, or both. Methods: Two infectious disease physicians conducted detailed medical record reviews on 150 randomly selected adults from 4 hospitals who died in-hospital following an NV-HAP event between April 2016 and May 2021. Reviewers abstracted risk factors, estimated the preventability of NV-HAP, identified causes of death, and adjudicated the preventability of death. Results: The patients' median age was 69.3 (IQR, 60.7-77.4) years and 43.3% were female. Comorbidities were common: 57% had cancer, 30% chronic kidney disease, 29% chronic lung disease, and 27% had heart failure. At least 1 hospice-eligible condition was present before NV-HAP in 54% and "Do Not Resuscitate" orders in 24%. Most (99%) had difficult-to-modify NV-HAP risk factors: 76% altered mental status, 35% dysphagia, and 27% nasogastric/orogastric tubes. NV-HAP was deemed possibly or probably preventable in 21% and hospital death likely or very likely preventable in 8.6%. Conclusions: Most patients who die following NV-HAP have multiple, severe underlying comorbidities and difficult-to-modify risk factors for NV-HAP. Only 1 in 5 NV-HAPs that culminated in death and 1 in 12 deaths following NV-HAP were judged potentially preventable. This does not diminish the importance of NV-HAP prevention programs but informs expectations about the potential magnitude of their impact on hospital deaths. Competing Interests: Potential conflicts of interest. A. M. T. had support from Harvard Catalyst, The Harvard Clinical and Translational Science Center (National Center for Advancing Translational Sciences, National Institutes of Health award UL1 TR002541), and financial contributions from Harvard University and its affiliated academic healthcare centers. A. A. acknowledges support from the National Institutes of Health (T32AI007061). M. K. and C. R. acknowledge grant support from CDC and AHRQ plus royalties from UpToDate. All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed. (© The Author(s) 2024. Published by Oxford University Press on behalf of Infectious Diseases Society of America. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)
Databáze:	MEDLINE
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