PPubMed1 Sep 2016Cited 33×

Trends in Pneumonia Mortality Rates and Hospitalizations by Organism, United States, 2002–2011 1 Trends in Pneumonia by Organism, United States

Brandon A. Wuerth, John P. Bonnewell, Timothy L. Wiemken, Forest W. Arnold

Abstract

'Forest W. Arnold'] Because the epidemiology of pneumonia is changing, we performed an updated, population-based analysis of hospitalization and case-fatality rates for pneumonia patients in the United States. From 2002 to 2011, hospitalization rates decreased significantly for pneumonia caused by pneumococcus and Haemophilus influenzae but increased significantly for Pseudomonas spp., Staphylococcus aureus, and influenza virus.

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Between 2002‑2011 US pneumonia hospitalizations rose for Klebsiella, Pseudomonas, S. aureus, and influenza, but fell for pneumococcus and H. influenzae; mortality trends varied by organism.

What’s new

i.Updated population‑based analysis of pneumonia hospitalizations and case‑fatality rates by organism for 2002‑2011 in the United States
ii.Identified increasing trends for Klebsiella, Pseudomonas, Staphylococcus aureus, and influenza virus and decreasing trends for pneumococcus and Haemophilus influenzae
iii.Provided regional variation data across US Census regions
iv.Included influenza virus as an etiologic agent, which many prior studies omitted
v.Calculated adjusted odds ratios for age, sex, and region using multivariate logistic regression

How they did it

The study used a retrospective cohort design analyzing discharge data from the Nationwide Inpatient Sample, a ≈20% stratified sample of US community hospitals. Cases were identified with ICD‑9‑CM codes for six major organisms and demographic variables were recorded. Adjusted odds ratios were estimated with multivariate logistic regression using SAS 9.3.

What they found

Hospitalization rates decreased 23% for pneumococcus and 42% for H. influenzae (p<0.001)
Hospitalization rates increased 35% for Klebsiella, 23% for Pseudomonas, 23% for S. aureus, and 132% for influenza virus (p<0.001)
Staphylococcus aureus was the most common organism at 19.2 cases per 100,000 population
Overall case‑fatality was highest for S. aureus at 15.6 deaths per 100 cases
Case‑fatality decreased 18% for pneumococcus and 32% for S. aureus, but increased 67% for influenza virus

Caveats

✕Reliance on ICD‑9‑CM coding may cause misclassification of cases
✕Inability to distinguish community‑acquired from hospital‑acquired pneumonia
✕Unspecified pneumonia cases without an identified organism were not examined
✕Case‑fatality rates reflect only in‑hospital deaths, not 30‑day outcomes

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