University of Western Australia, Royal Perth Hospital, Level 4, MRF Building, GPO Box X2213, Perth 6847, Australia; Northwestern University, Chicago, IL, USA.
Clin Chest Med. 2018 Dec;39(4):765-773. doi: 10.1016/j.ccm.2018.07.009.
"Health care-associated pneumonia (HCAP) was introduced into guidelines because of concerns about the increasing prevalence of drug-resistant pathogens (DRPs) not covered by standard empirical therapy. We now know that DRPs are very localized phenomena with low rates in most sites. Although HCAP risk factors are associated with a higher mortality, this is driven by comorbidities rather than the pathogens. Empirical coverage of DRPs has generally not resulted in better patient outcomes. A far more nuanced approach must be taken for patients with risk factors for DRPs taking into account the local cause and severity of disease.
由于担心标准经验性治疗无法覆盖的耐药病原体 (DRP) 的患病率不断增加，“与医疗保健相关的肺炎 (HCAP)” 被纳入了指南。我们现在知道，DRP 是一种非常局部的现象，在大多数部位的发生率都很低。虽然 HCAP 的危险因素与更高的死亡率相关，但这是由合并症引起的，而不是病原体引起的。DRP 的经验性治疗通常不会导致患者的结局更好。对于有 DRP 危险因素的患者，必须采取更为细致的方法，要考虑到当地疾病的病因和严重程度。
