Division of Respiratory Medicine, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan.
Geriatr Gerontol Int. 2014 Apr;14(2):362-71. doi: 10.1111/ggi.12110. Epub 2013 Jul 8.
Nursing and healthcare-associated pneumonia (NHCAP) is a modified category of healthcare-associated pneumonia adjusted for the healthcare system of Japan. The clinical characteristics and risk factors for mortality have not been well characterized in elderly patients with NHCAP.
We retrospectively investigated 960 consecutive patients aged ≥65 years admitted for pneumonia. Baseline characteristics, severity, pathogen distribution, outcomes and risk factors for mortality were compared between patients with community-acquired pneumonia (CAP) and those with NHCAP. The applicability of age, dehydration, respiratory failure, orientation disturbance, and low BP (A-DROP) score, a standard severity index for CAP in Japan, was also evaluated in NHCAP.
The study participants consisted of 373 patients (38.8%) with CAP and 587 (61.2%) with NHCAP. The patients with NHCAP were older and had poorer performance status (PS) and more comorbidities than those with CAP. The frequency of potentially drug-resistant (PDR) pathogens and in-hospital mortality were found in 10 (2.7%) and 17 patients (4.6%) with CAP, and 60 (10.2%) and 83 patients (14.1%) with NHCAP, respectively (P < 0.0001). The incidences of PDR pathogens and mortality were not significantly different among the criteria for NHCAP. The higher mortality was associated with PS, comorbidity with Charlson Comorbidity Index ≥3, and the coexistence of congestive heart failure, chronic kidney disease and malignancy. A-DROP score was poor at predicting mortality in most patients with NHCAP.
The current criteria for NHCAP seem to be appropriate for differentiating patients with poor outcomes from community-acquired pneumonia patients. It is essential to assess individual underlying conditions, such as PS and comorbidity, when caring for patients with NHCAP.
护理相关性肺炎（NHCAP）是根据日本医疗体系调整的医疗相关性肺炎的一个改良类别。年龄较大的 NHCAP 患者的临床特征和死亡率相关因素尚未得到很好的描述。
我们回顾性调查了 960 例年龄≥65 岁的因肺炎住院的连续患者。比较了社区获得性肺炎（CAP）和 NHCAP 患者的基线特征、严重程度、病原体分布、结局和死亡率相关因素。还评估了日本 CAP 的标准严重程度指数——年龄、脱水、呼吸衰竭、定向障碍和低血压（A-DROP）评分在 NHCAP 中的适用性。
研究参与者包括 373 例（38.8%）CAP 患者和 587 例（61.2%）NHCAP 患者。NHCAP 患者年龄较大，表现状态（PS）和合并症较差。CAP 患者中发现潜在耐药（PDR）病原体和院内死亡率分别为 10 例（2.7%）和 17 例（4.6%），NHCAP 患者中分别为 60 例（10.2%）和 83 例（14.1%）（P<0.0001）。NHCAP 的标准中，PDR 病原体和死亡率的发生率没有显著差异。较高的死亡率与 PS、Charlson 合并症指数≥3 以及充血性心力衰竭、慢性肾脏病和恶性肿瘤共存相关。A-DROP 评分在预测大多数 NHCAP 患者的死亡率方面表现不佳。
目前的 NHCAP 标准似乎适用于区分预后不良的患者和社区获得性肺炎患者。在照顾 NHCAP 患者时，评估 PS 和合并症等个体基础状况至关重要。
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