Critical Care Department, Hospital del Mar, Barcelona, Spain, and the Critical Illness Research Group (GREPAC), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain; Division of Pulmonary Diseases & Critical Care Medicine, University of Texas Health San Antonio, San Antonio, TX.
Division of Pulmonary Diseases & Critical Care Medicine, University of Texas Health San Antonio, San Antonio, TX; Respiratory Department, Hospital del Mar, IMIM, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Spain.
Chest. 2021 Jan;159(1):58-72. doi: 10.1016/j.chest.2020.06.079. Epub 2020 Jul 17.
Aspiration community-acquired pneumonia (ACAP) and community-acquired pneumonia (CAP) in patients with aspiration risk factors (AspRFs) are infections associated with anaerobes, but limited evidence suggests their pathogenic role.
What are the aspiration risk factors, microbiology patterns, and empiric anti-anaerobic use in patients hospitalized with CAP?
This is a secondary analysis of GLIMP, an international, multicenter, point-prevalence study of adults hospitalized with CAP. Patients were stratified into three groups: (1) ACAP, (2) CAP/AspRF+ (CAP with AspRF), and (3) CAP/AspRF- (CAP without AspRF). Data on demographics, comorbidities, microbiological results, and anti-anaerobic antibiotics were analyzed in all groups. Patients were further stratified in severe and nonsevere CAP groups.
We enrolled 2,606 patients with CAP, of which 193 (7.4%) had ACAP. Risk factors independently associated with ACAP were male, bedridden, underweight, a nursing home resident, and having a history of stroke, dementia, mental illness, and enteral tube feeding. Among non-ACAP patients, 1,709 (70.8%) had CAP/AspRF+ and 704 (29.2%) had CAP/AspRF-. Microbiology patterns including anaerobes were similar between CAP/AspRF-, CAP/AspRF+ and ACAP (0.0% vs 1.03% vs 1.64%). Patients with severe ACAP had higher rates of total gram-negative bacteria (64.3% vs 44.3% vs 33.3%, P = .021) and lower rates of total gram-positive bacteria (7.1% vs 38.1% vs 50.0%, P < .001) when compared with patients with severe CAP/AspRF+ and severe CAP/AspRF-, respectively. Most patients (>50% in all groups) independent of AspRFs or ACAP received specific or broad-spectrum anti-anaerobic coverage antibiotics.
Hospitalized patients with ACAP or CAP/AspRF+ had similar anaerobic flora compared with patients without aspiration risk factors. Gram-negative bacteria were more prevalent in patients with severe ACAP. Despite having similar microbiological flora between groups, a large proportion of CAP patients received anti-anaerobic antibiotic coverage.
有吸入风险因素（AspRF）的患者发生吸入性社区获得性肺炎（ACAP）和社区获得性肺炎（CAP）与厌氧菌有关，但有限的证据表明它们具有致病性。
住院治疗 CAP 的患者的吸入风险因素、微生物学模式和经验性抗厌氧菌使用情况如何？
这是一项对 GLIMP 的二次分析，GLIMP 是一项针对住院 CAP 患者的国际多中心时点患病率研究。患者分为三组：（1）ACAP，（2）CAP/AspRF+（有 AspRF 的 CAP），和（3）CAP/AspRF-（无 AspRF 的 CAP）。对所有组的人口统计学、合并症、微生物学结果和抗厌氧菌抗生素的数据进行了分析。患者进一步分为严重和非严重 CAP 组。
我们纳入了 2606 例 CAP 患者，其中 193 例（7.4%）患有 ACAP。与 ACAP 独立相关的危险因素是男性、卧床不起、体重过轻、居住在疗养院、有中风、痴呆、精神疾病和肠内喂养管的病史。在非 ACAP 患者中，1709 例（70.8%）有 CAP/AspRF+，704 例（29.2%）有 CAP/AspRF-。CAP/AspRF-、CAP/AspRF+和 ACAP 之间包括厌氧菌在内的微生物学模式相似（0.0%vs1.03%vs1.64%）。与严重 CAP/AspRF+和严重 CAP/AspRF-患者相比，严重 ACAP 患者的总革兰氏阴性菌（64.3%vs44.3%vs33.3%，P=0.021）的比例更高，而总革兰氏阳性菌（7.1%vs38.1%vs50.0%，P<0.001）的比例更低。与无 AspRF 或 ACAP 的患者相比，大多数患者（各组中>50%）都接受了特定或广谱抗厌氧菌覆盖抗生素治疗。
患有 ACAP 或 CAP/AspRF+的住院患者与无吸入风险因素的患者相比，厌氧菌的菌群相似。严重 ACAP 患者中革兰氏阴性菌更为常见。尽管各组之间的微生物学菌群相似，但很大一部分 CAP 患者接受了抗厌氧菌抗生素治疗。
