Lopes Mariana, Alves Silva Gonçalo, Nogueira Rui Filipe, Marado Daniela, Gonçalves João, Athayde Carlos, Silva Dilva, Figueiredo Ana, Fortuna Jorge, Carvalho Armando
Infectious Diseases Department, Coimbra Hospital and Universitary Centre, 3004-561 Coimbra, Portugal.
Nephrology Department, Coimbra Hospital and Universitary Centre, 3004-561 Coimbra, Portugal.
Infect Dis Rep. 2021 Jan 5;13(1):33-44. doi: 10.3390/idr13010006.
Nursing home-acquired pneumonia (NHAP) patients are at higher risk of multi-drug resistant infection (MDR) than those with community-acquired pneumonia (CAP). Recent evidence suggests a single risk factor for MDR does not accurately predict the need for broad-spectrum antibiotics. The goal of this study was to compare the rate antibiotic failure between NHAP and CAP patients.
Demographic characteristics, co-morbidities, clinical and laboratory variables, antibiotic therapy, and mortality data were collected retrospectively for all patients with pneumonia admitted to an Internal Medicine Service between April 2017 and April 2018.
In total, 313 of 556 patients had CAP and 243 had NHAP. NHAP patients were older, and were more likely to be dependent, to have recent antibiotic use, and to experience treatment failure (odds ratio (OR) 1.583; 95% CI 1.102-2.276; = 0.013). In multivariate analysis, patient's origin did not predict treatment failure (OR 1.083; 95% CI 0.726-1.616; = 0.696).
Higher rates of antibiotic failure and mortality in NHAP patients were explained by the presence of other risk factors such as comorbidities, more severe presentation, and age. Admission from a nursing home is not a sufficient condition to start broader-spectrum antibiotics.
与社区获得性肺炎（CAP）患者相比，养老院获得性肺炎（NHAP）患者发生多重耐药感染（MDR）的风险更高。最近的证据表明，单一的MDR风险因素并不能准确预测是否需要使用广谱抗生素。本研究的目的是比较NHAP患者和CAP患者抗生素治疗失败的发生率。
回顾性收集2017年4月至2018年4月间内科收治的所有肺炎患者的人口统计学特征、合并症、临床和实验室变量、抗生素治疗及死亡率数据。
556例患者中，313例患有CAP，243例患有NHAP。NHAP患者年龄更大，更可能存在依赖、近期使用过抗生素，且更易出现治疗失败（比值比（OR）1.583；95%置信区间1.102 - 2.276；P = 0.013）。多因素分析显示，患者来源并不能预测治疗失败（OR 1.083；95%置信区间0.726 - 1.616；P = 0.696）。
NHAP患者抗生素治疗失败率和死亡率较高是由合并症、病情更严重及年龄等其他风险因素导致的。来自养老院并非开始使用更广谱抗生素的充分条件。
