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Prior pneumococcal and influenza vaccinations and in‐hospital outcomes for community‐acquired pneumonia in elderly veterans
Author(s) -
Li Chenghui,
Gubbins Paul O.,
Chen Guoqing J.
Publication year - 2015
Publication title -
journal of hospital medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.128
H-Index - 65
eISSN - 1553-5606
pISSN - 1553-5592
DOI - 10.1002/jhm.2328
Subject(s) - medicine , bacteremia , vaccination , pneumonia , confidence interval , odds ratio , veterans affairs , retrospective cohort study , pneumococcal pneumonia , emergency medicine , community acquired pneumonia , logistic regression , pediatrics , streptococcus pneumoniae , immunology , genetics , bacteria , microbiology and biotechnology , biology , antibiotics
BACKGROUND Studies of adults hospitalized for community‐acquired pneumonia (CAP) reported better outcomes associated with prior pneumococcal vaccination (PV), suggesting potential additional benefits of PV in hospitalized CAP patients. Influenza (flu) vaccination (FV) could independently/additively improve CAP outcomes in hospitalized patients. OBJECTIVE To examine the effect of prior PV and FV on in‐hospital outcomes in elderly veterans hospitalized for CAP. DESIGN Retrospective cohort study. SETTING AND PATIENTS A total of 6,723 elderly veterans who were admitted to Veterans Affairs hospitals for CAP between October 1, 2002 and September 30, 2003. INTERVENTION PV in the 5 years and FV in the 1 year before admission. MEASUREMENTS The association of prior PV and/or FV with inpatient mortality and length of stay (LOS) (primary) and risk of any bacteremia and respiratory complications (secondary) were assessed using logistic regressions and generalized linear model, controlling for patient demographic and clinical characteristics. RESULTS Prior PV alone was not associated with shortened LOS, or reduced risk of inpatient mortality or respiratory complications. Lower risk of bacteremia was associated with prior PV (odds ratio: 0.66; 95% confidence interval [CI]: 0.48‐0.90). After adjusting for patients' characteristics, risk of inpatient mortality was not statistically significantly different across the vaccination groups, but having had both PV and FV before CAP admission was associated with a 10% reduction in LOS (95% CI: 0.86‐0.95) compared to having had neither vaccinations. CONCLUSION Significant survival benefit and improved in‐hospital outcomes may not be expected among CAP‐hospitalized elderly patients with prior PV alone. However, having both PV and FV before CAP admission may reduce LOS. Journal of Hospital Medicine 2015;10:287–293. © 2015 Society of Hospital Medicine