Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Respir Med. 2010 Nov;104(11):1729-35. doi: 10.1016/j.rmed.2010.06.009.
Health care-associated pneumonia (HCAP) has been proposed as a new category of respiratory infection. ATS/IDSA guidelines state that all patients with HCAP should receive empirical therapy directed at multidrug-resistant pathogens. However, recent data from other countries have reported a different picture of HCAP.
We conducted a retrospective observational study of patients with HCAP and CAP who were hospitalized through the emergency department in January-December 2008 at Samsung Medical Center, Seoul, Korea, and compared clinical characteristics, severity, distribution of pathogen, and outcomes.
In total, 345 patients hospitalized with pneumonia were eligible, 182 (52.8%) with HCAP and 163 (47.2%) with CAP. Patients with HCAP had greater comorbidity and higher Pneumonia Severity Index (PSI) score (P < 0.001). Although Streptococcus pneumoniae was the most frequently isolated pathogen in HCAP and CAP patients, the occurrence of potentially drug-resistant pathogens (29.3% vs. 13.0%; P = 0.044) and inappropriate initial antimicrobial treatment (24.6% vs. 8.7%; P = 0.032) were significantly higher in HCAP patients. Patients with HCAP had a longer duration of hospital stay (13 [8-18] vs. 8 [6-12] days; P < 0.001), and higher in-hospital mortality (19.2% vs. 7.4%; P = 0.001). In a multiple logistic regression analysis, however, in-hospital mortality was independently associated with higher PSI class (OR 2.82, 95% CI 1.19-6.70) and ICU admission (OR 15.37, 95% CI 3.58-66.05).
Severity of illness, rather than type of pneumonia, was the main predicting factor for in-hospital mortality among patients with pneumonia hospitalized through the emergency department.
卫生保健相关肺炎（HCAP）已被提议作为一种新的呼吸道感染类别。ATS/IDSA 指南指出，所有 HCAP 患者均应接受针对多药耐药病原体的经验性治疗。然而，来自其他国家的最新数据报告了 HCAP 的不同情况。
我们对 2008 年 1 月至 12 月期间因肺炎通过急诊在韩国首尔三星医疗中心住院的 HCAP 和 CAP 患者进行了回顾性观察性研究，并比较了临床特征、严重程度、病原体分布和结局。
共有 345 名患有肺炎的患者符合条件，其中 182 名（52.8%）为 HCAP，163 名（47.2%）为 CAP。HCAP 患者的合并症更多，肺炎严重指数（PSI）评分更高（P<0.001）。尽管肺炎链球菌是 HCAP 和 CAP 患者中最常分离的病原体，但潜在耐药病原体的发生率（29.3%比 13.0%；P=0.044）和初始抗菌治疗不当的发生率（24.6%比 8.7%；P=0.032）在 HCAP 患者中显著更高。HCAP 患者的住院时间更长（13[8-18]比 8[6-12]天；P<0.001），住院死亡率更高（19.2%比 7.4%；P=0.001）。然而，在多变量逻辑回归分析中，住院死亡率与更高的 PSI 分级（比值比 2.82，95%置信区间 1.19-6.70）和 ICU 入住（比值比 15.37，95%置信区间 3.58-66.05）独立相关。
在通过急诊住院的肺炎患者中，疾病严重程度而非肺炎类型是住院死亡率的主要预测因素。
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