Kara Sibel, Akçay Müşerref Şule, Ekici Ünsal Zuhal, Bozkurt Yılmaz Hatice Eylül, Habeşoğlu Mehmet Ali
Department of Chest Diseases, Baskent University Adana Dr. Turgut Noyan Application and Research Center, Adana, Turkey.
Clinic of Chest Diseases, Baskent University, Ankara Hospital, Ankara, Turkey.
Tuberk Toraks. 2019 Jun;67(2):108-115. doi: 10.5578/tt.68421.
The recently introduced concept of health care-associated pneumonia (HCAP), referring to patients with frequent healthcare contacts and at higher risk of contracting resistant pathogens is controversial.
A prospective study comparing patients with HCAP and community-acquired pneumonia (CAP) in the our center. The primary outcome was 30 day mortality.
A total of the 169 patients HCAP 36 (21.3%); CAP 133 (78.7%) were evaluated. HCAP patients were older than patients with CAP [median age was 72.5 (43-96), 60.0 (18-91) years p<0.05]. The most common Klebsiella pneumoniae (16.6%) and Pseudomonas aeruginosa (8.3%) were gram-negative bacteria in the SBİP group; In the TGP group, gram-positive bacteria were more frequently isolated. Polymicrobial agents (22.2% vs. 3.7% p<0.05) and MDR pathogens (57.1% vs. 24% p<0.05) were more common in patients with HCAP. Mortality rate (22.2% vs. 6% p<0.05) was also higher in HCAP more than CAP.
HCAP was common among patients with pneumonia requiring hospitalization and mortality rate was high. The patients with HCAP were different from CAP in terms of demographic and clinical features, etiology, outcome.
最近引入的医疗保健相关肺炎（HCAP）概念，指的是有频繁医疗接触且感染耐药病原体风险较高的患者，这一概念存在争议。
在我们中心进行一项前瞻性研究，比较HCAP患者和社区获得性肺炎（CAP）患者。主要结局是30天死亡率。
共评估了169例患者，其中HCAP患者36例（21.3%）；CAP患者133例（78.7%）。HCAP患者比CAP患者年龄更大[中位年龄分别为72.5（43 - 96）岁、60.0（18 - 91）岁，p<0.05]。SBİP组中最常见的革兰阴性菌是肺炎克雷伯菌（16.6%）和铜绿假单胞菌（8.3%）；在TGP组中，革兰阳性菌分离更为频繁。HCAP患者中多重微生物病原体（22.2%对3.7%，p<0.05）和多重耐药病原体（57.1%对24%，p<0.05）更为常见。HCAP患者的死亡率（22.2%对6%，p<0.05）也高于CAP患者。
HCAP在需要住院治疗的肺炎患者中很常见，且死亡率较高。HCAP患者在人口统计学和临床特征、病因、结局方面与CAP患者不同。
