Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Institute of Chest Disease, Yonsei University College of Medicine, Seoul, Republic of Korea.
BMC Infect Dis. 2011 Mar 11;11:61. doi: 10.1186/1471-2334-11-61.
Healthcare-associated pneumonia (HCAP) has more similarities to nosocomial pneumonia than to community-acquired pneumonia (CAP). However, there have only been a few epidemiological studies of HCAP in South Korea. We aimed to determine the differences between HCAP and CAP in terms of clinical features, pathogens, and outcomes, and to clarify approaches for initial antibiotic management.
We conducted a retrospective, observational study of 527 patients with HCAP or CAP who were hospitalized at Severance Hospital in South Korea between January and December 2008.
Of these patients, 231 (43.8%) had HCAP, and 296 (56.2%) had CAP. Potentially drug-resistant (PDR) bacteria were more frequently isolated in HCAP than CAP (12.6% vs. 4.7%; P = 0.001), especially in the low-risk group of the PSI classes (41.2% vs. 13.9%; P = 0.027). In-hospital mortality was higher for HCAP than CAP patients (28.1% vs. 10.8%, P < 0.001), especially in the low-risk group of PSI classes (16.4% vs. 3.1%; P = 0.001). Moreover, tube feeding and prior hospitalization with antibiotic treatment within 90 days of pneumonia onset were significant risk factors for PDR pathogens, with odds ratios of 14.94 (95% CI 4.62-48.31; P < 0.001) and 2.68 (95% CI 1.32-5.46; P = 0.007), respectively.
For HCAP patients with different backgrounds, various pathogens and antibiotic resistance of should be considered, and careful selection of patients requiring broad-spectrum antibiotics is important when physicians start initial antibiotic treatments.
与社区获得性肺炎（CAP）相比，医疗保健相关性肺炎（HCAP）与医院获得性肺炎（HAP）更相似。然而，在韩国仅有少数关于 HCAP 的流行病学研究。我们旨在确定 HCAP 和 CAP 在临床特征、病原体和结局方面的差异，并阐明初始抗生素管理的方法。
我们对 2008 年 1 月至 12 月期间在韩国 Severance 医院住院的 527 例 HCAP 或 CAP 患者进行了回顾性、观察性研究。
这些患者中，231 例（43.8%）患有 HCAP，296 例（56.2%）患有 CAP。HCAP 中分离出的潜在耐药（PDR）细菌比 CAP 更常见（12.6% vs. 4.7%；P = 0.001），尤其是在 PSI 分级的低危组（41.2% vs. 13.9%；P = 0.027）。HCAP 患者的住院死亡率高于 CAP 患者（28.1% vs. 10.8%，P < 0.001），尤其是在 PSI 分级的低危组（16.4% vs. 3.1%；P = 0.001）。此外，管饲和肺炎发病前 90 天内有抗生素治疗的住院史是 PDR 病原体的显著危险因素，比值比分别为 14.94（95%CI 4.62-48.31；P < 0.001）和 2.68（95%CI 1.32-5.46；P = 0.007）。
对于具有不同背景的 HCAP 患者，应考虑各种病原体和抗生素耐药性，并在医生开始初始抗生素治疗时，谨慎选择需要广谱抗生素治疗的患者。
