Risk factors for hospital-acquired pneumonia among inpatients with mental disorders in a large mental health center within a tertiary general hospital


      • Hospital-acquired pneumonia (HAP) was common in inpatients with mental disorders.
      • HAP incidence was higher in patients on closed wards than in those on open wards.
      • HAP was prevalent in patients with organic mental disorders or schizophrenia.
      • HAP prolonged the hospitalization of inpatients with mental disorders.
      • Patients with mental disorders have unique risk factors for HAP.



      : Few researchers have investigated the incidence of and risk factors for hospital-acquired pneumonia (HAP) among inpatients with mental disorders in a general hospital.


      : This study included patients with mental disorders hospitalized in a large mental health center (situated in a general hospital) between January 1, 2017 and July 31, 2021 (excluding January 1, 2020 to May 31, 2020). Risk factors for HAP were identified by logistic regression analysis after propensity score matching (PSM, 1:4) for gender, age, duration of observation and hospital ward.


      : The study included 16,864 patients. HAP incidence rate was 1.15% overall, 2.11% on closed wards, 0.75% on open wards, 4.45% in patients with organic mental disorders, 1.80% in patients with schizophrenia spectrum disorder, and 0.84% in patients with mood disorders. Risk factors for HAP after PSM were hypoproteinemia, chronic liver disease, use of clozapine, hospitalization during the previous 180 days, body mass index (BMI) ≤18.5 kg/m2, cholinesterase inhibitor use and mood stabilizer use.


      : HAP was common among inpatients with mental disorders. Risk factors for HAP in patients with mental disorders include hypoproteinemia, chronic liver disease, hospitalization during the past 180 days, BMI ≤18.5 kg/m2, and use of clozapine, cholinesterase inhibitors or mood stabilizers.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to American Journal of Infection Control
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Rehm J
        • Shield KD.
        Global Burden of Disease and the Impact of Mental and Addictive Disorders.
        Curr Psychiatry Rep. 2019; 21: 10
        • Charlson FJ
        • Baxter AJ
        • Cheng HG
        • Shidhaye R
        • Whiteford HA.
        The burden of mental, neurological, and substance use disorders in China and India: a systematic analysis of community representative epidemiological studies.
        Lancet. 2016; 388: 376-389
        • The Ministry of Health of the People's Republic of China
        China Health Statistical Yearbook 2015.
        Peking Union Medical College Press, Beijing2016
        • Chen W
        • Wang S
        • Wang Q
        • Wang W.
        Direct medical costs of hospitalisations for mental disorders in Shanghai, China: a time series study.
        BMJ Open. 2017; 7e015652
        • Kalil AC
        • Metersky ML
        • Klompas M
        • Muscedere J
        • Sweeney DA
        • Palmer LB
        • et al.
        Management of Adults With Hospital-acquired and Ventilator-associated Pneumonia: 2016 Clinical Practice Guidelines by the Infectious Diseases Society of America and the American Thoracic Society.
        Clin Infect Dis. 2016 Sep 1; 63: e61-e111
        • Shi Y
        • Huang Y
        • Zhang TT
        • Cao B
        • Wang H
        • Zhuo C
        • et al.
        Chinese guidelines for the diagnosis and treatment of hospital-acquired pneumonia and ventilator-associated pneumonia in adults.
        J Thorac Dis. 2019; 11: 2581-2616
        • Bail K
        • Goss J
        • Draper B
        • Berry H
        • Karmel R
        • Gibson D.
        The cost of hospital-acquired complications for older people with and without dementia; a retrospective cohort study.
        BMC Health Serv Res. 2015; 15: 91
        • Manabe T
        • Fujikura Y
        • Mizukami K
        • Akatsu H
        • Kudo K.
        Pneumonia-associated death in patients with dementia: A systematic review and meta-analysis.
        PLOS One. 2019; 14e0213825
        • Chan HY
        • Lai CL
        • Lin YC
        • Hsu CC.
        Is Antipsychotic Treatment Associated With Risk of Pneumonia in People With Serious Mental Illness?: The Roles of Severity of Psychiatric Symptoms and Global Functioning.
        J Clin Psychopharmacol. 2019; 39: 434-440
        • Yang M
        • Li Q
        • Wang C
        • Li L
        • Xu M
        • Yan F
        • et al.
        Influencing Factors of Hospital-Acquired Pneumonia Infection in the Middle-Aged and Elderly Patients With Schizophrenia.
        Front Psychiatry. 2021; 12746791
        • Vignari M.
        Non-ventilator health care-associated pneumonia (NV-HAP): NV-HAP Risk Factors.
        Am J Infect Control. 2020; 48: A10-A13
        • Schoepf D
        • Uppal H
        • Potluri R
        • Heun R.
        Physical comorbidity and its relevance on mortality in schizophrenia: a naturalistic 12-year follow-up in general hospital admissions.
        Eur Arch Psychiatry Clin Neurosci. 2014; 264: 3-28
        • De Hert M
        • Cohen D
        • Bobes J
        • Cetkovich-Bakmas M
        • Leucht S
        • Ndetei DM
        • et al.
        Physical illness in patients with severe mental disorders. II. Barriers to care, monitoring and treatment guidelines, plus recommendations at the system and individual level.
        World Psychiatry. 2011; 10: 138-151
        • Romano PS
        • Roos LL
        • Jollis JG.
        Adapting a clinical comorbidity index for use with ICD-9-CM administrative data: differing perspectives.
        J Clin Epidemiol. 1993; 46 (1075-9; discussion 1081-90)
        • Baker D
        • Quinn B.
        Hospital Acquired Pneumonia Prevention Initiative-2: Incidence of nonventilator hospital-acquired pneumonia in the United States.
        Am J Infect Control. 2018; 46: 2-7
        • Wiedermann CJ.
        Hypoalbuminemia as Surrogate and Culprit of Infections.
        Int J Mol Sci. 2021; 22: 4496
        • Sugai T
        • Suzuki Y
        • Yamazaki M
        • Shimoda K
        • Mori T
        • Ozeki Y
        • et al.
        High prevalence of underweight and undernutrition in Japanese inpatients with schizophrenia: a nationwide survey.
        BMJ Open. 2015; 5e008720
        • Dupuis C
        • Sabra A
        • Patrier J
        • Chaize G
        • Saighi A
        • Féger C
        • et al.
        Burden of pneumococcal pneumonia requiring ICU admission in France: 1-year prognosis, resources use, and costs.
        Crit Care. 2021; 25: 24
        • Hsu JH
        • Chien IC
        • Lin CH
        • Chou YJ
        • Chou P.
        Increased risk of chronic liver disease in patients with schizophrenia: a population-based cohort study.
        Psychosomatics. 2014; 55: 163-171
        • Hung GC
        • Liu HC
        • Yang SY
        • Pan CH
        • Liao YT
        • Chen CC
        • et al.
        Antipsychotic reexposure and recurrent pneumonia in schizophrenia: a nested case-control study.
        J Clin Psychiatry. 2016; 77: 60-66
        • de Leon J
        • Sanz EJ
        • Norén GN
        • De Las Cuevas C.
        Pneumonia may be more frequent and have more fatal outcomes with clozapine than with other second-generation antipsychotics.
        World Psychiatry. 2020; 19: 120-121
        • Chatterjee S
        • Carnahan RM
        • Chen H
        • Holmes HM
        • Johnson ML
        • Aparasu RR.
        Anticholinergic Medication Use and Risk of Pneumonia in Elderly Adults: A Nested Case-Control Study.
        J Am Geriatr Soc. 2016; 64: 394-400
        • Ness J
        • Hoth A
        • Barnett MJ
        • Shorr RI
        • Kaboli PJ.
        Anticholinergic medications in community-dwelling older veterans: prevalence of anticholinergic symptoms, symptom burden, and adverse drug events.
        Am J Geriatr Pharmacother. 2006; 4: 42-51
        • Taipale H
        • Lampela P
        • Koponen M
        • Tanskanen A
        • Tiihonen J
        • Hartikainen S
        • et al.
        Antiepileptic Drug Use Is Associated with an Increased Risk of Pneumonia Among Community-Dwelling Persons with Alzheimer's Disease-Matched Cohort Study.
        J Alzheimers Dis. 2019; 68: 127-136
        • Foley NC
        • Affoo RH
        • Martin RE.
        A systematic review and meta-analysis examining pneumonia-associated mortality in dementia.
        Dement Geriatr Cogn Disord. 2015; 39: 52-67