From the Faculty of Medicine, School of Health Sciences, University of Iceland , Reykjavik , Iceland.
Infect Dis (Lond). 2015 Mar;47(3):130-6. doi: 10.3109/00365548.2014.980842. Epub 2015 Jan 24.
The classification of pneumonia as community-acquired pneumonia (CAP) or healthcare-associated pneumonia (HCAP) has implications for selection of initial antimicrobial therapy. HCAP has been associated with an increased prevalence of multidrug-resistant (MDR) pathogens and with high mortality leading to recommendations for broad empiric therapy.
We performed a prospective, population-based study on consecutive adults (≥ 18 years) admitted for pneumonia over 1 calendar year. Patients were classified by pneumonia type and severity. Microbial etiologic testing was performed on all patients. Treatment, length of stay, and mortality rates were compared.
A total of 373 admissions were included, 94% of all eligible patients. They were classified as CAP (n = 236, 63%) or HCAP (n = 137, 37%). Chronic underlying disease was more commonly found among patients with HCAP compared with CAP (74% vs 51%, p < 0.001). Mycoplasma pneumoniae was more common among CAP patients (p < 0.01), while gram-negative bacteria were more often found among HCAP patients (p = 0.02). No MDR pathogens were detected, and rates of Staphylococcus aureus were similar in the two groups. HCAP patients were not more likely to receive ineffective initial antimicrobial therapy. HCAP patients had worse prognostic scores on admission and higher in-house mortality than CAP patients (10% vs 1%, respectively, p < 0.01).
Even in a low resistance setting, patients with HCAP have increased mortality compared with patients with CAP. This is most likely explained by a higher prevalence of co-morbidities. Our data do not support broad-spectrum empiric antibiotic therapy for HCAP.
肺炎分为社区获得性肺炎（CAP）或医疗保健相关性肺炎（HCAP），这对初始抗菌治疗方案的选择有影响。HCAP 与多种耐药（MDR）病原体的患病率增加和高死亡率相关，因此建议进行广泛的经验性治疗。
我们对 1 个日历年内连续因肺炎入院的成年患者（≥18 岁）进行了前瞻性、基于人群的研究。根据肺炎类型和严重程度对患者进行分类。对所有患者进行微生物病因学检测。比较治疗、住院时间和死亡率。
共纳入 373 例住院患者，占所有合格患者的 94%。他们被分为 CAP（n=236，63%）或 HCAP（n=137，37%）。与 CAP 患者相比，HCAP 患者更常患有慢性基础疾病（74% vs 51%，p<0.001）。肺炎支原体在 CAP 患者中更为常见（p<0.01），而革兰氏阴性菌在 HCAP 患者中更为常见（p=0.02）。未发现 MDR 病原体，两组金黄色葡萄球菌的发生率相似。HCAP 患者初始抗菌治疗无效的可能性并不高。HCAP 患者入院时预后评分较差，院内死亡率高于 CAP 患者（分别为 10%和 1%，p<0.01）。
即使在耐药率较低的情况下，HCAP 患者的死亡率也高于 CAP 患者。这很可能是由于合并症的患病率较高所致。我们的数据不支持对 HCAP 进行广谱经验性抗生素治疗。
