重症监护病房中既往肺结核对 HCAP 和 CAP 患者治疗结局的影响。

Impact of prior pulmonary tuberculosis in treatment outcomes of HCAP and CAP patients in intensive care units.

机构信息

Division of Pulmonary Medicine, Department of Internal Medicine, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan.

Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan.

出版信息

J Microbiol Immunol Infect. 2019 Apr;52(2):320-328. doi: 10.1016/j.jmii.2018.08.012. Epub 2018 Sep 5.

DOI:10.1016/j.jmii.2018.08.012

PMID:30245205

Abstract

BACKGROUND/PURPOSE: It is controversial whether healthcare-associated pneumonia (HCAP) belongs to a unique clinical entity or it shares common characteristics with community-acquired pneumonia (CAP). The impact of prior pulmonary tuberculosis (PTB) in clinical presentation and treatment outcome of ICU-admitted CAP and HCAP patients also remains unknown.

METHODS

We report a nationwide, multi-center, retrospective study. ICU-admitted CAP and HCAP patients from six medical centers in Taiwan were enrolled for analysis. Patients were defined as either CAP or HCAP cases, and with and without prior PTB, according to the database of Taiwan CDC. The disease severity, microbiologic characteristics, and treatment outcomes between CAP and HCAP patients with or without prior PTB were compared and analyzed.

RESULTS

A total of 414 ICU-admitted patients, including 176 CAP cases and 238 HCAP cases were included for analysis during the study period. In both CAP and HCAP subgroups, the pneumonia severities, proportions of organ dysfunction, and microbiologic characteristics were similar between patients with and without prior PTB. In survival analysis, patients with prior PTB had higher 30-day mortality than those without prior PTB (38.9% vs. 16.5%, p = 0.021) in the CAP population. Multivariate analysis revealed that a history of prior PTB was an independent clinical factor associated with higher 30-day mortality rate in CAP patients (HR = 4.45, 95% CI: 1.81-10.98, P = 0.001).

CONCLUSION

History of prior PTB is an independent clinical factor for increased 30-day mortality rate in ICU-admitted CAP patients, but not in ICU-admitted HCAP patients.

摘要

背景/目的：医疗相关性肺炎（HCAP）是否属于独特的临床实体，或者它与社区获得性肺炎（CAP）是否具有共同特征，这一点存在争议。先前患有肺结核（PTB）对 ICU 收治的 CAP 和 HCAP 患者的临床表现和治疗结果的影响也尚不清楚。

方法

我们报告了一项全国性、多中心、回顾性研究。从台湾 6 家医疗中心的 ICU 收治的 CAP 和 HCAP 患者中招募了患者进行分析。根据台湾疾病控制署的数据库，患者被定义为 CAP 或 HCAP 病例，并根据是否有先前的 PTB 进行分类。比较和分析了有或无先前 PTB 的 CAP 和 HCAP 患者的疾病严重程度、微生物特征和治疗结果。

结果

在研究期间，共纳入了 414 例 ICU 收治的患者，包括 176 例 CAP 病例和 238 例 HCAP 病例。在 CAP 和 HCAP 亚组中，有或无先前 PTB 的患者的肺炎严重程度、器官功能障碍比例和微生物特征相似。在生存分析中，与无先前 PTB 的患者相比，先前患有 PTB 的 CAP 患者的 30 天死亡率更高（38.9% vs. 16.5%，p=0.021）。多变量分析显示，先前患有 PTB 是 CAP 患者 30 天死亡率升高的独立临床因素（HR=4.45，95%CI：1.81-10.98，P=0.001）。