Department of Medicine and Therapeutics, 9/F, Clinical Science Building, Prince of Wales Hospital, The Chinese University of Hong Kong, 32 Ngan Shing Street, Shatin, NT, HKSAR.
QJM. 2013 Sep;106(9):823-9. doi: 10.1093/qjmed/hct152. Epub 2013 Jul 12.
The relationship between healthcare-associated pneumonia (HCAP) and resistant bacteria is unclear. The aim of this study was to identify the risk factors for pneumonia caused by drug-resistant bacteria (DRB).
A prospective cohort study was conducted at a tertiary teaching hospital in Hong Kong. Consecutive older patients (aged ≥65 years) were hospitalized with pneumonia from January 2004 to June 2005. DRB comprised methicillin-resistant Staphylococcus aureus (MRSA), Pseudomonas aeruginosa, extended-spectrum β-lactamase (ESBL) producing Enterobacteriaceae and Acinetobacter baumannii.
The entire cohort consisted of 1176 older patients. Of 472 (40.1%) patients with etiological diagnosis established, bacterial pneumonia was found in 354 (30.1%) cases. DRB were isolated in 48 patients: P. aeruginosa (41), MRSA (5) and ESBL producing enteric bacilli (3). Co-infection with P. aeruginosa and MRSA was found in one patient. The prevalence of DRB in culture-positive pneumonia was 20.1% (48/239). Patients with DRB were more likely to have limitation in activities of daily living, bronchiectasis, dementia, severe pneumonia, recent hospitalization and recent antibiotic use. Logistic regression revealed that bronchiectasis [relative risk (RR) 14.12, P = 0.002], recent hospitalization (RR 4.89, P < 0.001) and severe pneumonia (RR 2.42, P = 0.010) were independent predictors of drug-resistant bacterial pneumonia.
Recent hospitalization is the only risk factor for HCAP which is shown to be associated with DRB. Nursing home residence is not a risk factor. The concept of HCAP may not be totally applicable in Hong Kong where the prevalence of drug-resistant pathogens in pneumonia is low.
医疗相关性肺炎（HCAP）与耐药菌之间的关系尚不清楚。本研究旨在确定耐药菌（DRB）引起肺炎的危险因素。
本研究采用前瞻性队列研究，在香港一家三级教学医院进行。连续入组 2004 年 1 月至 2005 年 6 月期间因肺炎住院的年龄≥65 岁的老年患者。DRB 包括耐甲氧西林金黄色葡萄球菌（MRSA）、铜绿假单胞菌、产超广谱β-内酰胺酶（ESBL）的肠杆菌科细菌和鲍曼不动杆菌。
整个队列共包括 1176 例老年患者。在确定病因诊断的 472 例患者中，40.1%（354 例）的患者存在细菌性肺炎。在 48 例患者中分离出 DRB：铜绿假单胞菌（41 例）、MRSA（5 例）和产 ESBL 的肠杆菌科细菌（3 例）。1 例患者同时感染铜绿假单胞菌和 MRSA。在培养阳性肺炎患者中，DRB 的检出率为 20.1%（48/239）。患有 DRB 的患者更可能存在日常生活活动受限、支气管扩张、痴呆、严重肺炎、近期住院和近期使用抗生素。Logistic 回归分析显示，支气管扩张（相对风险 [RR] 14.12，P = 0.002）、近期住院（RR 4.89，P < 0.001）和严重肺炎（RR 2.42，P = 0.010）是耐药菌肺炎的独立预测因素。
近期住院是唯一与 HCAP 相关的危险因素，且与 DRB 相关。养老院居住不是危险因素。在耐药病原体在肺炎中发生率较低的香港，HCAP 的概念可能不完全适用。
