Infectious Disease, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Hospital Universitari de Bellvitge, University of Barcelona, L'Hospitalet de LLobregat, Barcelona, Spain.
Clin Microbiol Infect. 2011 Nov;17(11):1659-65. doi: 10.1111/j.1469-0691.2011.03484.x. Epub 2011 Apr 4.
Healthcare-associated pneumonia (HCAP) includes a broad spectrum of patients who acquire pneumonia through outpatient contact with the health system. Although limited prospective data exist, it has been suggested that all patients with HCAP should receive empirical therapy with a multidrug regimen directed against drug-resistant organisms. We aimed to determine the differences in aetiology and outcomes between HCAP groups and a community-acquired pneumonia (CAP) group, and to assess the presence of antibiotic-resistant bacteria. All consecutive non-immunocompromised adults hospitalized with pneumonia were prospectively included from 2001 to 2009. Patients who had had recent contact with the health system through nursing homes, home healthcare programmes, haemodialysis clinics or prior hospitalization were considered to have HCAP. A total of 2245 patients with pneumonia were hospitalized through the emergency room, of whom 577 (25.7%) had HCAP. Significant differences in causative pathogens were found between groups. Antibiotic-resistant organisms, including methicillin-resistant Staphylococcus aureus, resistant strains of Pseudomonas aeruginosa, and extended-spectrum β-lactamase-producing Enterobacteriaceae, were scarce in all groups. In contrast, aspiration pneumonia was particularly frequent. No differences were found regarding inappropriate initial empirical antibiotic therapy between groups. Overall mortality was higher in patients who attended a hospital or haemodialysis clinic or received intravenous chemotherapy in the 30 days before pneumonia, and among patients who resided in a nursing home or long-term-care facility. In conclusion, most HCAP patients could be treated in the same way as patients with CAP, after carefully ruling out the presence of aspiration pneumonia.
医院获得性肺炎（HCAP）包括一系列通过门诊与医疗系统接触而感染肺炎的患者。尽管存在有限的前瞻性数据，但有人建议，所有 HCAP 患者均应接受针对耐药菌的多药经验性治疗。我们旨在确定 HCAP 组与社区获得性肺炎（CAP）组之间的病因和结局差异，并评估是否存在抗生素耐药菌。2001 年至 2009 年，连续纳入所有因肺炎住院且无免疫功能低下的成年人。有近期通过疗养院、家庭保健计划、血液透析诊所或先前住院与医疗系统接触的患者被认为患有 HCAP。共有 2245 名肺炎患者通过急诊室住院，其中 577 名（25.7%）患有 HCAP。各组之间的病原体存在显著差异。所有组中均很少发现抗生素耐药菌，包括耐甲氧西林金黄色葡萄球菌、耐多药铜绿假单胞菌和产超广谱β-内酰胺酶的肠杆菌科。相比之下，吸入性肺炎尤为常见。各组之间的初始经验性抗生素治疗不合理的比例无差异。在肺炎发生前 30 天内曾就诊于医院或血液透析诊所或接受过静脉化疗，或居住在疗养院或长期护理机构的患者的总体死亡率较高。总之，在仔细排除吸入性肺炎的情况下，大多数 HCAP 患者可以与 CAP 患者一样接受治疗。
