Intensive Care Unit-Unidade de Cuidados Intensivos Polivalente-Hospital Geral de Santo António, Abel Salazar Biomedical Sciences Institute, University of Porto, Porto, Portugal.
PLoS One. 2013;8(3):e58418. doi: 10.1371/journal.pone.0058418. Epub 2013 Mar 8.
To understand if clinicians can tell apart patients with healthcare-associated infections (HCAI) from those with community-acquired infections (CAI) and to determine the impact of HCAI in the adequacy of initial antibiotic therapy and hospital mortality.
One-year prospective cohort study including all consecutive infected patients admitted to a large university tertiary care hospital.
A total of 1035 patients were included in this study. There were 718 patients admitted from the community: 225 (31%) with HCAI and 493 (69%) with CAI. Total microbiologic documentation rate of infection was 68% (n = 703): 56% in CAI, 73% in HCAI and 83% in hospital-acquired infections (HAI). Antibiotic therapy was inadequate in 27% of patients with HCAI vs. 14% of patients with CAI (p<0.001). Among patients with HCAI, 47% received antibiotic therapy in accordance with international recommendations for treatment of CAI. Antibiotic therapy was inadequate in 36% of patients with HCAI whose treatment followed international recommendations for CAI vs. 19% in the group of HCAI patients whose treatment did not follow these guidelines (p = 0.014). Variables independently associated with inadequate antibiotic therapy were: decreased functional capacity (adjusted OR = 2.24), HCAI (adjusted OR = 2.09) and HAI (adjusted OR = 2.24). Variables independently associated with higher hospital mortality were: age (adjusted OR = 1.05, per year), severe sepsis (adjusted OR = 1.92), septic shock (adjusted OR = 8.13) and inadequate antibiotic therapy (adjusted OR = 1.99).
HCAI was associated with an increased rate of inadequate antibiotic therapy but not with a significant increase in hospital mortality. Clinicians need to be aware of healthcare-associated infections among the group of infected patients arriving from the community since the existing guidelines regarding antibiotic therapy do not apply to this group and they will otherwise receive inadequate antibiotic therapy which will have a negative impact on hospital outcome.
了解临床医生是否能够区分医源性感染（HAI）与社区获得性感染（CAI）患者，并确定 HAI 对初始抗生素治疗的充分性和医院死亡率的影响。
一项为期 1 年的前瞻性队列研究，纳入了所有入住一家大型大学三级保健医院的连续感染患者。
这项研究共纳入 1035 名患者。其中 718 名患者从社区入院：225 名（31%）为 HAI，493 名（69%）为 CAI。感染的总微生物学记录率为 68%（n=703）：CAI 为 56%，HAI 为 73%，医院获得性感染（HAI）为 83%。HAI 患者中抗生素治疗不充分的比例为 27%，而 CAI 患者为 14%（p<0.001）。在 HAI 患者中，47%的患者接受了符合 CAI 治疗国际推荐的抗生素治疗。遵循 CAI 国际治疗建议的 HAI 患者中，抗生素治疗不充分的比例为 36%，而不遵循这些指南的 HAI 患者为 19%（p=0.014）。与抗生素治疗不充分相关的独立变量包括：功能能力下降（调整后的 OR=2.24）、HAI（调整后的 OR=2.09）和 HAI（调整后的 OR=2.24）。与更高医院死亡率相关的独立变量包括：年龄（调整后的 OR=1.05，每年）、严重败血症（调整后的 OR=1.92）、感染性休克（调整后的 OR=8.13）和抗生素治疗不充分（调整后的 OR=1.99）。
HAI 与抗生素治疗不充分的发生率增加有关，但与医院死亡率的显著增加无关。临床医生需要意识到来自社区的感染患者中存在医源性感染，因为现有的抗生素治疗指南不适用于这组患者，否则他们将接受不充分的抗生素治疗，这将对医院结果产生负面影响。
