Ishida Tadashi, Tachibana Hiromasa, Ito Akihiro, Yoshioka Hiroshige, Arita Machiko, Hashimoto Toru
Department of Respiratory Medicine, Kurashiki Central Hospital, Japan.
Intern Med. 2012;51(18):2537-44. doi: 10.2169/internalmedicine.51.7987. Epub 2012 Sep 15.
The aim of this study was to describe the epidemiology, clinical features, antimicrobial treatment, and outcomes of patients with nursing and healthcare-associated pneumonia (NHCAP); a new category of pneumonia proposed by the Japanese Respiratory Society.
We conducted a retrospective analysis of a prospectively collected database of patients with NHCAP and community-acquired pneumonia (CAP) hospitalized at a single center between January 2008 and December 2010, and compared their clinical characteristics. The criteria for NHCAP were as follows: (1) residence in a nursing home or an extended-care ward, (2) a discharge from a hospital in the preceding 90 days, (3) an elderly or handicapped patient who needs long-term care, (4) a patient who regularly requires vascular access in an outpatient setting.
A total of 442 NHCAP patients and 451 CAP patients were evaluated. The NHCAP patients were older and had a higher frequency of underlying diseases. Aspiration was thought to be associated with the NHCAP in 63% of patients. Streptococcus pneumoniae was the leading pathogen in both groups, whereas the frequency of multidrug-resistant pathogens was higher in the NHCAP patients. The most frequently used antimicrobials in NHCAP patients were penicillins with beta-lactamase inhibitors. The in-hospital mortality and recurrence rates were significantly higher in NHCAP patients than in CAP patients (13.1% vs. 5.1%, p<0.001 and 18.8% vs. 5.5%, p<0.001).
The clinical picture of NHCAP is consistent with that of HCAP described in the past. It is thought to be of benefit to modify the healthcare-associated pneumonia (HCAP) criteria considering the healthcare and social health insurance system in Japan.
本研究旨在描述护理及医疗保健相关肺炎（NHCAP）患者的流行病学、临床特征、抗菌治疗及转归；NHCAP是日本呼吸学会提出的一种新型肺炎。
我们对2008年1月至2010年12月在单中心住院的NHCAP患者和社区获得性肺炎（CAP）患者的前瞻性收集数据库进行了回顾性分析，并比较了他们的临床特征。NHCAP的标准如下：（1）居住在养老院或长期护理病房；（2）在过去90天内曾出院；（3）需要长期护理的老年或残疾患者；（4）在门诊环境中经常需要血管通路的患者。
共评估了442例NHCAP患者和451例CAP患者。NHCAP患者年龄较大，基础疾病发生率较高。63%的患者认为误吸与NHCAP有关。肺炎链球菌是两组中的主要病原体，而NHCAP患者中多重耐药病原体的发生率较高。NHCAP患者最常用的抗菌药物是含β-内酰胺酶抑制剂的青霉素。NHCAP患者的院内死亡率和复发率显著高于CAP患者（13.1%对5.1%，p<0.001；18.8%对5.5%，p<0.001）。
NHCAP的临床表现与过去描述的HCAP一致。考虑到日本的医疗保健和社会医疗保险系统，修改医疗保健相关肺炎（HCAP）标准可能有益。
