Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea.
Department of Digital Health, SAIHST, Sungkyunkawan University, Seoul, South Korea.
BMC Pulm Med. 2022 Jan 12;22(1):21. doi: 10.1186/s12890-021-01816-9.
Social and hospital environmental factors that may be associated with hospital-acquired pneumonia (HAP) have not been evaluated. Comprehensive risk assessment for the incidence of HAP including sociodemographic, clinical, and hospital environmental factors was conducted using national health insurance claims data.
This is a population-based retrospective cohort study of adult patients who were hospitalized for more than 3 days from the Health Insurance Review and Assessment Service-National Inpatient Sample data between January 1, 2016 and December 31, 2018 in South Korea. Multivariable logistic regression analyses were conducted to identify the factors associated with the incidence of HAP.
Among the 512,278 hospitalizations, we identified 25,369 (5.0%) HAP cases. In multivariable analysis, well-known risk factors associated with HAP such as older age (over 70 vs. 20-29; adjusted odds ratio [aOR], 3.66; 95% confidence interval [CI] 3.36-3.99), male sex (aOR, 1.35; 95% CI 1.32-1.39), pre-existing lung diseases (asthma [aOR, 1.73; 95% CI 1.66-1.80]; chronic obstructive pulmonary disease [aOR, 1.62; 95% CI 1.53-1.71]; chronic lower airway disease [aOR, 1.79; 95% CI 1.73-1.85]), tube feeding (aOR, 3.32; 95% CI 3.16-3.50), suctioning (aOR, 2.34; 95% CI 2.23-2.47), positioning (aOR, 1.63; 95% CI 1.55-1.72), use of mechanical ventilation (aOR, 2.31; 95% CI 2.15-2.47), and intensive care unit admission (aOR, 1.29; 95% CI 1.22-1.36) were associated with the incidence of HAP. In addition, poverty (aOR, 1.08; 95% CI 1.04-1.13), general hospitals (aOR, 1.54; 95% CI 1.39-1.70), higher bed-to-nurse ratio (Grade ≥ 5; aOR, 1.45; 95% CI 1.32-1.59), higher number of beds per hospital room (6 beds; aOR, 3.08; 95% CI 2.77-3.42), and ward with caregiver (aOR, 1.19; 95% CI 1.12-1.26) were related to the incidence of HAP.
The incidence of HAP was associated with various sociodemographic, clinical, and hospital environmental factors. Thus, taking a comprehensive approach to prevent and treat HAP is important.
可能与医院获得性肺炎（HAP）相关的社会和医院环境因素尚未得到评估。利用国家健康保险索赔数据，对包括社会人口统计学、临床和医院环境因素在内的 HAP 发病综合风险进行了评估。
这是一项基于人群的回顾性队列研究，纳入了 2016 年 1 月 1 日至 2018 年 12 月 31 日期间在韩国健康保险审查与评估服务-国家住院患者样本中住院时间超过 3 天的成年患者。采用多变量逻辑回归分析确定与 HAP 发病率相关的因素。
在 512278 例住院患者中，我们确定了 25369 例（5.0%）HAP 病例。在多变量分析中，与 HAP 相关的已知危险因素，如年龄较大（>70 岁与 20-29 岁；调整后的优势比[aOR]，3.66；95%置信区间[CI]，3.36-3.99）、男性（aOR，1.35；95%CI，1.32-1.39）、预先存在的肺部疾病（哮喘[aOR，1.73；95%CI，1.66-1.80]；慢性阻塞性肺疾病[aOR，1.62；95%CI，1.53-1.71]；慢性下呼吸道疾病[aOR，1.79；95%CI，1.73-1.85]）、管饲（aOR，3.32；95%CI，3.16-3.50）、抽吸（aOR，2.34；95%CI，2.23-2.47）、定位（aOR，1.63；95%CI，1.55-1.72）、使用机械通气（aOR，2.31；95%CI，2.15-2.47）和重症监护病房入院（aOR，1.29；95%CI，1.22-1.36）与 HAP 的发生相关。此外，贫困（aOR，1.08；95%CI，1.04-1.13）、综合医院（aOR，1.54；95%CI，1.39-1.70）、较高的床位护士比（≥5 级；aOR，1.45；95%CI，1.32-1.59）、每间病房更多的床位（6 张床；aOR，3.08；95%CI，2.77-3.42）和有护理人员的病房（aOR，1.19；95%CI，1.12-1.26）与 HAP 的发生相关。
HAP 的发病率与各种社会人口统计学、临床和医院环境因素有关。因此，采取综合方法预防和治疗 HAP 很重要。
