LTC BULLETIN BOARD
Infection Spotlight: Page 2 of 2
Study Finds Atypical Pathogens Are Not a Significant Cause of Nursing Home–Acquired Pneumonia
Atypical pathogens (APs), such as Mycoplasma pneumonia, Chlamydia pneumonia, and Legionella pneumophila have been implicated in up to 40% of cases of community-acquired pneumonia (www.aafp.org/afp/2004/0401/p1699.html). Guidelines advise empiric antibiotics to treat atypical pneumonia; however, until recently, these guidelines have not thoroughly addressed prevalence and treatment of atypical nursing home–acquired pneumonia (NHAP).
Diagnosis and management of NHAP is complex because of the high prevalence of frailty, cognitive impairment, and polypharmacy in nursing home residents. In a new study, specialists at the Division of Geriatric Medicine, Chinese University of Hong Kong, sought to investigate the prevalence and clinical characteristics of AP infections and the need for empirical antibiotics in NHAP. Ma Hon-ming and colleagues conducted a prospective cohort study involving a total of 127 nursing home residents (aged ≥65 years) who had been hospitalized for NHAP. Annals of Long-Term Care® (ALTC) had the opportunity to interview Ma about the findings of the study, which were recently published in the Journal of the American Medical Directors Association (www.ncbi.nlm.nih.gov/pubmed/23206723).
ALTC: There is a lack of consensus data regarding empiric antibiotic therapy in patients with NHAP caused by an AP. What does your study add to the medical literature and the clinical understanding of treating NHAP?
Dr. Ma: Our study adds to the literature that APs are not an important cause of NHAP, as evidenced by the low prevalence (10.2%) and the lack of antibiotic treatment not resulting in mortality. Therefore, NHAP does not need to be treated routinely with antibiotics covering APs. Furthermore, Legionella pneumophila was not detected in our cohort, confirming its rarity in NHAP, as found in previous studies.
In your study, 12 APs were detected in 11 patients, the most common of which were Mycoplasma pneumonia and Chlamydia pneumonia. None of the 11 patients received antibiotics indicated for atypical infection; however, you noted that AP infections did not result in mortality. Were you and your colleagues surprised by this finding?
It is intriguing that NHAP caused by APs does not lead to any mortality even in the absence of appropriate antibiotic treatment. We believe that APs, like the majority of respiratory viruses, cause influenza-like illness and pneumonia of milder severity. Their clinical courses are usually self-limiting. Antibiotics with atypical coverage should be added empirically if patients do not respond to beta-lactam antibiotics or develop severe pneumonia.
What is the next step of research in the area of preventing and treating NHAP?
The importance of dental hygiene and mouth care is the focus of future research in preventing NHAP. Besides, it is controversial if NHAP should be treated according to the community-acquired pneumonia or healthcare-associated pneumonia guidelines because of the increasing prevalence of drug-resistant pathogens. We believe that risk stratification is the best approach to guide clinicians in choosing appropriate empirical antibiotics for NHAP. Future work is directed at identifying the most significant risk factors for resistant organisms in NHAP.
New App Allows Year-Round Influenza Monitoring
Although the influenza season tends to peak in January and February, flu activity can begin as early as October and linger well into May. To help clinicians stay up-to-date with national flu activity year-round, the Centers for Disease Control and Prevention (CDC) has created a new application for the iPad, iPhone, and iPod Touch. The app enables instant access to vaccination recommendations from the CDC and the Advisory Committee on Immunization Practices for healthcare providers working in any care setting. The app’s database includes information on diagnosis and treatment of influenza, including laboratory testing and antiviral treatment recommendations. Users can individualize the app to their needs with features such as highlighting, notes, and bookmarks. Free resources can be downloaded from the app for office use or distribution to patients. The app is available for free from the iTunes App Store. Download it at https://itunes.apple.com/us/app/cdc-influenza-flu/id577782055.