Lee Hongyeul, Park Ji Young, Lee Taehoon, Lee Yeon Joo, Lim Hyo-Jeong, Park Jong Sun, Yoon Ho Il, Lee Jae-Ho, Lee Choon-Taek, Cho Young-Jae
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
Korean J Intern Med. 2016 May;31(3):525-34. doi: 10.3904/kjim.2015.103. Epub 2016 Mar 11.
BACKGROUND/AIMS: Healthcare-associated pneumonia (HCAP) was proposed asa new pneumonia category in 2005, and treatment recommendations includebroad-spectrum antibiotics directed at multidrug-resistant (MDR) pathogens.However, this concept continues to be controversial, and microbiological data arelacking for HCAP patients in the intensive care unit (ICU). This study was conductedto determine the rate and type of antibiotic-resistant organisms and theclinical outcomes in patients with HCAP in the ICU, compared to patients withcommunity-acquired pneumonia (CAP) or hospital-acquired pneumonia (HAP).
We conducted a retrospective cohort analysis of patients with pneumonia(n = 195) who admitted to medical ICU in tertiary teaching hospital fromMarch 2011 to February 2013. Clinical characteristics, microbiological distributions,treatment outcomes, and prognosis of HCAP (n = 74) were compared tothose of CAP (n = 75) and HAP (n = 46).
MDR pathogens were significantly higher in HCAP patients (39.1%) thanin CAP (13.5%) and lower than in HAP (79.3%, p < 0.001). The initial use of inappropriateantibiotic treatment occurred more frequently in the HCAP (32.6%) andHAP (51.7%) groups than in the CAP group (11.8%, p = 0.006). There were no differencesin clinical outcomes. The significant prognostic factors were pneumoniaseverity and treatment response.
MDR pathogens were isolated in HCAP patients requiring ICU admissionat intermediate rates between those of CAP and HAP.
背景/目的：医疗保健相关肺炎（HCAP）于2005年被提出作为一种新的肺炎类别，其治疗建议包括针对多重耐药（MDR）病原体的广谱抗生素。然而，这一概念仍存在争议，且重症监护病房（ICU）中HCAP患者的微生物学数据缺乏。本研究旨在确定ICU中HCAP患者抗生素耐药菌的发生率和类型以及临床结局，并与社区获得性肺炎（CAP）或医院获得性肺炎（HAP）患者进行比较。
我们对2011年3月至2013年2月在三级教学医院内科ICU住院的肺炎患者（n = 195）进行了回顾性队列分析。将HCAP患者（n = 74）的临床特征、微生物分布、治疗结局和预后与CAP患者（n = 75）和HAP患者（n = 46）进行比较。
HCAP患者中MDR病原体的比例（39.1%）显著高于CAP患者（13.5%），但低于HAP患者（79.3%，p < 0.001）。HCAP组（32.6%）和HAP组（51.7%）初始使用不恰当抗生素治疗的频率高于CAP组（11.8%，p = 0.006）。临床结局无差异。重要的预后因素是肺炎严重程度和治疗反应。
入住ICU的HCAP患者中分离出MDR病原体的比例介于CAP和HAP患者之间。
