Department of Respiratory Medicine, Okinawa Chubu Hospital, 281 Azamiyazato, Uruma City, Okinawa, 904-2293, Japan.
J Infect Chemother. 2013 Aug;19(4):719-26. doi: 10.1007/s10156-013-0557-1. Epub 2013 Jan 25.
Nursing- and healthcare-associated pneumonia (NHCAP) has been proposed by the Japanese Respiratory Society as a new category of pneumonia considering the characteristics of the Japanese medical care environment. It is necessary to ascertain the epidemiology and clinical outcomes of NHCAP. A prospective study was conducted of patients with pneumonia who were hospitalized at our hospital from August 2011 to July 2012. We compared 192 cases of NHCAP with 114 cases of community-acquired pneumonia (CAP). Compared with CAP, NHCAP had a higher disease severity, higher 30-day mortality rate (10.9 vs. 3.5 %, P = 0.022), and longer length of hospital stay (median, 12 vs. 8 days, P < 0.001). Streptococcus pneumoniae was the most frequent causative pathogen in both NHCAP and CAP (33.9 vs. 34.8 %, P = 0.896). The incidence of atypical pathogens in NHCAP was low (1.7 %). Multidrug-resistant (MDR) pathogens were isolated more frequently in NHCAP than in CAP, but there was no significant difference (11.0 vs. 4.5 %, P = 0.135). Among 192 NHCAP patients, 122 (63.5 %) were aspiration pneumonia. Aspiration pneumonia was associated with poor outcomes and was considered a major characteristic of NHCAP. Our study suggested that many patients with NHCAP do not need broad-spectrum antibiotic therapy targeting MDR pathogens. Excess mortality in NHCAP patients is the result of patient backgrounds or disease severity rather than the presence of MDR pathogens.
日本呼吸学会提出了医疗保健相关肺炎（NHCAP）这一新型肺炎类别，考虑到日本医疗保健环境的特点。有必要确定 NHCAP 的流行病学和临床结局。我们对 2011 年 8 月至 2012 年 7 月在我院住院的肺炎患者进行了一项前瞻性研究。我们比较了 192 例 NHCAP 患者和 114 例社区获得性肺炎（CAP）患者。与 CAP 相比，NHCAP 疾病严重程度更高，30 天死亡率更高（10.9% vs. 3.5%，P=0.022），住院时间更长（中位数 12 天 vs. 8 天，P<0.001）。肺炎链球菌是 NHCAP 和 CAP 中最常见的病原体（33.9% vs. 34.8%，P=0.896）。非典型病原体在 NHCAP 中的发病率较低（1.7%）。NHCAP 中分离出的耐药菌（MDR）比 CAP 更常见，但差异无统计学意义（11.0% vs. 4.5%，P=0.135）。在 192 例 NHCAP 患者中，122 例（63.5%）为吸入性肺炎。吸入性肺炎与不良预后相关，被认为是 NHCAP 的主要特征。我们的研究表明，许多 NHCAP 患者不需要针对 MDR 病原体的广谱抗生素治疗。NHCAP 患者的死亡率过高是患者背景或疾病严重程度的结果，而不是 MDR 病原体的存在。
