13 The burden of hospital acquired pneumonia after hip fracture surgery: shifting focus beyond surgical site infections

Introduction In 2013, an Irish Hip Fracture Database (IHFD) was established, aiming to improve care to older adults with hip fractures. In 2023, 3983 cases (93% coverage; 269 from our centre) with median age of 80 years were included. The median length-of-stay (LOS) was 12 days, and 0.4% developed a surgical site infection (SSI). A national study of hospital-acquired infections (HAI) in May 2023 reported hospital-acquired pneumonia (HAP) as the most common HAI (27% of all HAI, with 2% prevalence). Aim To undertake a pilot surveillance study to determine the incidence of HAP in patients following hip fracture surgery. Methods Prospective review of all hip fracture admissions to one tertiary hospital over three months (October–December 2024) to identify those prescribed empiric antimicrobials for clinical diagnosis of suspected HAP. Each case was assessed against European HAP surveillance definitions, as utilised in the 2023 national study of HAI in Ireland. Results There were 64 hip fracture admissions, of whom 19 were male (30%), and mean age was 78 years. Seven were prescribed antimicrobials for suspected HAP (11%; mean = 7 day course), of whom five were male (71%), with a mean age of 87 years. Piperacillin-tazobactam was most commonly prescribed for HAP treatment (n = 5; 71%). Of those treated for HAP, 5 had chest x-rays performed, four of whom (80%) had radiological evidence for pneumonia. Five (71%) were febrile (≥38°C), four (57%) had white blood cells ≥12 or <4 × 109/L. No patient had a respiratory specimen sent for culture, while five (71%) had blood cultures taken, all sterile. Respiratory viral testing was performed on four (57%), with one case of influenza diagnosed. No patient treated for suspected HAP fulfilled the European HAP surveillance criteria. Comparing those treated for HAP with the overall cohort, the mean interval from ED presentation to orthopaedic ward admission was similar (7 h). Patients treated for HAP had a slightly longer mean LOS (13.5 days) versus the overall cohort (12.8 days). Conclusions In a three-month prospective study of 64 patients following hip fracture surgery in a tertiary hospital in Ireland, 11% were treated with broad spectrum empiric antimicrobials for suspected HAP. As no sputum culture was available, de-escalation was not feasible. The European HAP surveillance definition was not applicable in this elderly cohort. As a HAI, HAP far exceeds SSI in patients post hip fracture surgery. Targeted HAP prevention measures should be considered for this elderly, at-risk patient cohort.