Pulmonary and Critical Care Medicine, Washington Hospital Center, Washington, DC, USA.
Chest. 2010 Jun;137(6):1283-8. doi: 10.1378/chest.09-2434. Epub 2010 Feb 12.
The concept of health-care-associated pneumonia (HCAP) exists to identify patients infected with highly resistant pathogens. It is unclear how precise this concept is and how well it performs as a screening tool for resistance.
We retrospectively identified patients presenting to the hospital with pneumonia complicated by respiratory failure. We examined the microbiology of these infections based on pneumonia type and determined the sensitivity and specificity of HCAP as a screen for resistance. Through logistic regression and modeling, we created a scoring tool for determining who may be infected with resistant pathogens.
The cohort included 190 subjects (37% with ARDS) and we noted resistant pathogens in 33%. Resistance was more common in HCAP (78% vs 44%, P = .001). HCAP alone performed poorly as a screening test (sensitivity and specificity 78.3% and 56.2%, respectively). Variables independently associated with a resistant organism included immunosuppression (adjusted odds ratio [AOR] 4.85, P < .001), long-term care admission (AOR 2.36, P = .029), and prior antibiotics (AOR 2.12, P = .099). A decision rule based only on these factors performed moderately well at identifying resistant infections. The presence of HCAP itself, based on meeting defined criteria, was not independently associated with resistance using logistic regression to control for covariates.
HCAP is common in patients presenting to the hospital with pneumonia leading to respiratory failure. The HCAP concept does not correlate well with the presence of infection due to a resistant pathogen. A simpler clinical decision rule based on select HCAP criteria performs as well as the HCAP concept for potentially guiding antibiotic decision making.
卫生保健相关性肺炎（HCAP）的概念旨在确定感染高度耐药病原体的患者。目前尚不清楚该概念的准确性如何，以及作为耐药性筛查工具的性能如何。
我们回顾性地确定了因肺炎合并呼吸衰竭而住院的患者。我们根据肺炎类型检查这些感染的微生物，并确定 HCAP 作为耐药性筛查的敏感性和特异性。通过逻辑回归和建模，我们创建了一个用于确定可能感染耐药病原体的评分工具。
该队列包括 190 名患者（37%为 ARDS），我们发现 33%的患者感染了耐药病原体。HCAP 患者的耐药性更为常见（78%比 44%，P =.001）。HCAP 单独作为筛查试验的性能不佳（敏感性和特异性分别为 78.3%和 56.2%）。与耐药病原体独立相关的变量包括免疫抑制（调整后的优势比 [AOR] 4.85，P <.001）、长期护理入院（AOR 2.36，P =.029）和先前使用抗生素（AOR 2.12，P =.099）。仅基于这些因素的决策规则在识别耐药感染方面表现良好。根据定义的标准确定的 HCAP 本身的存在，在使用逻辑回归控制协变量时，与耐药感染的相关性并不独立。
HCAP 在因肺炎导致呼吸衰竭而住院的患者中很常见。HCAP 概念与感染耐药病原体的相关性不佳。基于特定 HCAP 标准的更简单临床决策规则与 HCAP 概念一样，可潜在指导抗生素决策。
