Corrado Rachel E, Lee David, Lucero David E, Varma Jay K, Vora Neil M
Division of Disease Control, New York City Department of Health and Mental Hygiene, Queens, NY.
Division of Disease Control, New York City Department of Health and Mental Hygiene, Queens, NY; National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA.
Chest. 2017 Nov;152(5):930-942. doi: 10.1016/j.chest.2017.04.162. Epub 2017 Apr 26.
Although pneumonia is a leading cause of death in New York City (NYC), limited data exist about the settings in which pneumonia is acquired across NYC. Cases of pneumonia acquired in community settings are more likely to be preventable with vaccines and treatable with first-line antibiotics than those acquired in noncommunity settings. The objective of this study was to estimate the burden of hospitalizations associated with community-acquired (CAP), health-care-associated (HCAP), hospital-acquired (HAP), and ventilator-associated (VAP) pneumonia from 2010 to 2014.
This retrospective analysis was performed by using an all-payer reporting system of hospital discharges that included NYC residents aged ≥ 18 years. Pneumonia-associated hospitalizations were defined as any hospitalization that included a diagnostic code for pneumonia among any of the discharge diagnoses. Using published clinical guidelines, we classified hospitalizations into mutually exclusive categories of CAP, HCAP, HAP, and VAP and defined pneumonia acquired in the community setting as the combination of CAP and HCAP.
Of 4,614,108 hospitalizations during the reporting period, 283,927 (6.2%) involved pneumonia. Among pneumonia-associated hospitalizations, 154,158 (54.3%) were CAP, 85,656 (30.2%) were HCAP, 39,712 (14.0%) were HAP, and 4,401 (1.6%) were VAP. Death during hospitalization occurred in 7.9% of CAP-associated hospitalizations, compared with 15.6% of HCAP-associated hospitalizations, 20.7% of HAP-associated hospitalizations, and 21.6% of VAP-associated hospitalizations.
Most pneumonia-associated hospitalizations in NYC involve pneumonias acquired in the community setting. Although 15.6% of pneumonia-associated hospitalizations were categorized as HAP or VAP, these pneumonias accounted for > 25% of deaths from pneumonia-associated hospitalizations. Public health pneumonia prevention efforts need to target both community and hospital settings.
尽管肺炎是纽约市（NYC）的主要死因之一，但关于纽约市各地肺炎获得环境的数据有限。与在非社区环境中获得的肺炎相比，在社区环境中获得的肺炎病例更有可能通过疫苗预防，并可用一线抗生素治疗。本研究的目的是估计2010年至2014年与社区获得性（CAP）、医疗保健相关（HCAP）、医院获得性（HAP）和呼吸机相关性（VAP）肺炎相关的住院负担。
本回顾性分析使用了一个包括年龄≥18岁的纽约市居民的全支付者医院出院报告系统进行。与肺炎相关的住院定义为在任何出院诊断中包括肺炎诊断代码的任何住院。使用已发表的临床指南，我们将住院分为CAP、HCAP、HAP和VAP的相互排斥类别，并将在社区环境中获得的肺炎定义为CAP和HCAP的组合。
在报告期内的4,614,108例住院中，283,927例（6.2%）涉及肺炎。在与肺炎相关的住院中，154,158例（54.3%）为CAP，85,656例（30.2%）为HCAP，39,712例（14.0%）为HAP，4,401例（1.6%）为VAP。与CAP相关的住院中有7.9%在住院期间死亡，而与HCAP相关的住院中有15.6%、与HAP相关的住院中有20.7%、与VAP相关的住院中有21.6%。
纽约市大多数与肺炎相关的住院涉及在社区环境中获得的肺炎。尽管15.6%的与肺炎相关的住院被归类为HAP或VAP，但这些肺炎占与肺炎相关住院死亡的25%以上。公共卫生肺炎预防工作需要针对社区和医院环境。
