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Multicenter Study
. 2022 Dec 9;17(12):e0276192.
doi: 10.1371/journal.pone.0276192. eCollection 2022.

Descriptive epidemiology of hospitalized patients with bacterial nosocomial pneumonia who experience 30-day readmission in the US, 2014-2019

Marya D Zilberberg  1 , Brian H Nathanson  2 , Laura A Puzniak  3 , Noah W D Zilberberg  1   4 , Andrew F Shorr  5
Affiliations
Multicenter Study

Descriptive epidemiology of hospitalized patients with bacterial nosocomial pneumonia who experience 30-day readmission in the US, 2014-2019

Marya D Zilberberg et al. PLoS One. .

Abstract

Introduction: Nosocomial pneumonia (NP) remains associated with excess morbidity and mortality. The effect of NP on measures such as re-admission at 30 days remains unclear. Moreover, differing types of NP may have varying impacts on re-admissions.

Methods: We conducted a multicenter retrospective cohort study within the Premier Research database, a source containing administrative, pharmacy, and microbiology data. We compared NP patients readmitted with pneumonia (RaP) as the principal diagnosis to those readmitted for other reasons (RaO) with respect to the type of NP (ventilator-associated bacterial pneumonia [VABP], ventilated hospital-acquired bacterial pneumonia [vHABP], and non-ventilated HABP [nvHABP]), and characteristics and outcomes of the index hospitalization.

Results: Among 17,819 patients with NP, 14,123 (79.3%) survived to discharge, of whom 2,151 (15.2%) required an acute readmission within 30 days of index discharge. Of these, 106 (4.9%) were RaP, and the remainder were RaO. At index hospitalization, RaP patients were older (mean age [SD] 67.4 (13.9] vs. 63.0 [15.2] years), more likely medical (44.3% vs. 36.7%), and less chronically ill (median [IQR] Charlson scores (3 [2-5] vs. 4 [2-5]) than persons with RaO. Bacteremia (10.4% vs. 17.5%), need for vasopressors (15.1% vs. 20.0%), dialysis (9.4% vs. 16.5%), and/or sepsis (9.4% vs. 16.5%) or septic shock 14.2% vs. 17.1%) occurred less frequently in the RaP group. With respect to NP type, nvHABP was most common in RaP (47.2%) and VABP in RaO (38.1%).

Conclusions: One in seven survivors of a hospitalization complicated by NP requires an acute rehospitalization within 30 days. However, few of these readmissions had a principal diagnosis of pneumonia, irrespective of NP type. Of the 5% of NP subjects with RaP, the plurality initially suffered from nvHABP.

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Conflict of interest statement

I have read the journal’s policy. In addition to funding statement above, the following potential competing interest exist: •MDZ and AFS have received grant support and/or have served as consultants to Lungpacer, Melinta, Tetraphase, Pfizer, Astellas, Shionogi, The Medicines Company, Spero, and Theravance.

Figures

Fig 1
Fig 1. Index hospitalization illness severity measures.
RaP = readmission for pneumonia; RaO = readmission for another condition. *P = 0.005. **P = 0.053.
Fig 2
Fig 2. Index hospitalization complications.
RaP = readmission for pneumonia; RaO = readmission for another condition; ICU = intensive care unit; MV = mechanical ventilation. *P = 0.005. **P = 0.059.
Fig 3
Fig 3
Resource use (A) and costs (B) associated with the index hospitalization among patients re-hospitalized due to pneumonia (RaP) or other reasons (RaO). RaP = readmission for pneumonia; RaO = readmission for another condition; LOS = length of stay; ICU = intensive care unit; MV = mechanical ventilation.
See this image and copyright information in PMC

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