Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, 660 S Euclid Ave, Campus Box 8052, St. Louis, MO 63110, USA.
Chest. 2010 May;137(5):1130-7. doi: 10.1378/chest.09-1652. Epub 2009 Dec 4.
The aim of this study is to describe the initial antibiotic treatment regimens, severity of illness, and in-hospital mortality among culture-negative (CN) and culture-positive (CP) patients with health-care-associated pneumonia (HCAP).
We used a retrospective cohort study, examining adult patients with HCAP from Barnes-Jewish Hospital, a 1,200-bed urban teaching hospital.
Eight hundred seventy patients with HCAP were identified over a 3-year period (January 2003 through December 2005) of whom 431 (49.5%) were CP. Among the non-CP patients, 290 (66.1%) had no respiratory cultures obtained, and 149 (33.9%) had no growth or nonpathogenic oral flora identified and were classified as CN. CN patients were more likely to have received an initial antibiotic regimen (ceftriaxone +/- azithromycin or moxifloxacin) targeting community-acquired pneumonia pathogens compared with CP patients (71.8% vs 25.5%, P < .001). Severity of illness as assessed by ICU admission and mechanical ventilation (MV) was statistically lower in CN compared with CP patients (ICU admittance 12.1% vs 48.7%, P < .001; MV: 6.7% vs 44.5%, P < .001). In-hospital mortality and hospital length of stay were also statistically lower for CN patients (mortality: 7.4% vs 24.6%, P < .001; hospital length of stay: 6.7 +/- 7.4 days vs 12.1 +/- 11.7 days, P < .001).
In this analysis, patients with CN HCAP had lower severity of illness, hospital mortality, and hospital length of stay compared with CP patients. These data suggest that patients with CN HCAP differ substantially from patients with HCAP with positive microbiologic cultures.
本研究旨在描述与医疗保健相关的肺炎（HCAP）中培养阴性（CN）和培养阳性（CP）患者的初始抗生素治疗方案、疾病严重程度和住院死亡率。
我们使用回顾性队列研究，检查了 Barnes-Jewish 医院的 HCAP 成年患者，该医院是一家拥有 1200 张床位的城市教学医院。
在 3 年期间（2003 年 1 月至 2005 年 12 月），共确定了 870 例 HCAP 患者，其中 431 例（49.5%）为 CP。在非 CP 患者中，290 例（66.1%）未进行呼吸道培养，149 例（33.9%）未发现生长或非致病性口腔菌群，被归类为 CN。与 CP 患者相比，CN 患者更有可能接受针对社区获得性肺炎病原体的初始抗生素治疗方案（头孢曲松 +/- 阿奇霉素或莫西沙星）（71.8%比 25.5%，P <.001）。CN 患者的疾病严重程度，如 ICU 入院和机械通气（MV）的评估，明显低于 CP 患者（ICU 入院率 12.1%比 48.7%，P <.001；MV：6.7%比 44.5%，P <.001）。CN 患者的住院死亡率和住院时间也明显低于 CP 患者（死亡率：7.4%比 24.6%，P <.001；住院时间：6.7 +/- 7.4 天比 12.1 +/- 11.7 天，P <.001）。
在这项分析中，与 CP 患者相比，CN HCAP 患者的疾病严重程度、住院死亡率和住院时间更短。这些数据表明，与培养阳性微生物的 HCAP 患者相比，CN HCAP 患者有很大的不同。
