Epidemiology and Risk Factors of Hospital-Acquired Pneumonia in Chinese Adults: A Multicenter Retrospective Study

BACKGROUND Hospital-acquired pneumonia (HAP), including its special type, ventilator-associated pneumonia (VAP), is one of the most important types of hospital-acquired infections. A paucity of large-scale epidemiological data on HAP in China remains. Therefore, we conducted a multi-center retrospective study to investigate the epidemiology, etiology, and risk factors of HAP with the goal of improving early prevention and prognosis.

METHODS From January to December 2019, 543 patients from 37 tertiary hospitals meeting the enrollment criteria (who meet the diagnosis of HAP/VAP according to the 2018 Chinese HAP/VAP Guideline and have clear clinical outcomes) were included. Patient data were retrospectively analyzed.

RESULTS The mortality of enrolled patients was 15.8%. Risk factors for poor prognosis and mortality among HAP patients included a diagnosis of VAP, admission to the Intensive Care Unit (ICU), positive airway secretion culture, liver dysfunction, history of heart failure, history of cancer, long-term catheter indwelling, Sequential Organ Failure Assessment (SOFA) score >2 and quick SOFA (qSOFA) score >1 (P<0.05). The top four pathogens of HAP were Acinetobacter baumannii (24.89%), Klebsiella pneumoniae (21.57%), Pseudomonas aeruginosa (13.73%) and Staphylococcus aureus (5.88%).

CONCLUSION Given the high mortality rate associated with HAP, prevention and early diagnostic assessment of HAP and VAP during hospitalization are paramount for these patients. The main pathogens of HAP are Gram-negative bacteria, which frequently exhibit substantial antimicrobial resistance. Therefore, antibiotics should be selected carefully.