Wang Ping-Huai, Wang Hao-Chien, Cheng Shih-Lung, Chang Hou-Tai, Laio Chun-Hsing
Division of Thoracic Medicine, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
J Formos Med Assoc. 2016 May;115(5):356-63. doi: 10.1016/j.jfma.2015.03.009. Epub 2015 May 2.
BACKGROUND/PURPOSE: The pneumonia severity index (PSI) both contains some risk factors of drug-resistant pathogens (DRPs) and represents the severity of health care-associated pneumonia. The aim of this study was to investigate whether the PSI could be used to predict DRPs and whether there were risk factors beyond the PSI.
A retrospective observational study enrolled 530 patients with health care-associated pneumonia who were admitted from January 2005 to December 2010 in a tertiary care hospital.
A total of 206 patients (38.9%) had DRPs, of which the most common was Pseudomonas aeruginosa (24.3%). The incidence of DRPs increased with increasing PSI classes (6.7%, 25.5%, 36.9%, and 44.6% in PSI II, III, IV, and V, respectively). An analysis of the risk factors for DRPs by PSI classes revealed that wound care was associated with methicillin-resistant Staphylococcus aureus (MRSA) infection in PSI V (p = 0.045). Nasogastric tube feeding (odds ratio, 3.88; 95% confidence interval, 1.75-8.60; p = 0.006), and bronchiectasis (odds ratio, 3.12; 95% confidence interval, 0.66-14.69; p = 0.007) were risk factors for DRPs in PSI III and IV. The area under the receiver operating characteristic curve progressed from 0.578 to 0.651 while integrating these risk factors with PSI classes.
The findings suggested that PSI plus risk factors predicted the risk of DRPs. PSI II had a low risk of DRPs and could be treated as community-acquired pneumonia. Antibiotics of PSI III and IV with risk factors could be targeted DRPs. PSI V with wound care had a higher risk of MRSA, and empirical anti-MRSA antibiotics could be added.
背景/目的：肺炎严重程度指数（PSI）既包含耐药病原体（DRP）的一些危险因素，又代表医疗保健相关肺炎的严重程度。本研究的目的是调查PSI是否可用于预测DRP，以及是否存在超出PSI的危险因素。
一项回顾性观察研究纳入了2005年1月至2010年12月在一家三级护理医院住院的530例医疗保健相关肺炎患者。
共有206例患者（38.9%）存在DRP，其中最常见的是铜绿假单胞菌（24.3%）。DRP的发生率随着PSI等级的增加而升高（PSI II、III、IV和V级中分别为6.7%、25.5%、36.9%和44.6%）。按PSI等级对DRP的危险因素进行分析显示，伤口护理与PSI V级中的耐甲氧西林金黄色葡萄球菌（MRSA）感染相关（p = 0.045）。鼻胃管喂养（比值比，3.88；95%置信区间，1.75 - 8.60；p = 0.006）和支气管扩张（比值比，3.12；95%置信区间，0.66 - 14.69；p = 0.007）是PSI III级和IV级中DRP的危险因素。将这些危险因素与PSI等级相结合时，受试者工作特征曲线下面积从0.578提高到了0.651。
研究结果表明，PSI加上危险因素可预测DRP的风险。PSI II级发生DRP的风险较低，可按社区获得性肺炎治疗。存在危险因素的PSI III级和IV级患者使用抗生素时可针对DRP。有伤口护理的PSI V级患者发生MRSA感染的风险较高，可加用经验性抗MRSA抗生素。
