Epidemiology and outcomes of health-care-associated pneumonia - Results from a large US database of culture-positive pneumonia
Epidemiology and outcomes of health-care-associated pneumonia - Results from a large US database of culture-positive pneumonia
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DOI：
10.1378/chest.128.6.3854
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发表时间：
2005-12-01
期刊：
影响因子：
9.6
通讯作者：
Johannes, RS
中科院分区：
文献类型：
--
作者：
Kollef, MH;Shorr, A;Johannes, RS
内容：传统上，在医院外发生的肺炎被归类为社区获得性肺炎，即使这些患者一直在门诊接受医疗保健。越来越多的证据表明，卫生保健相关性感染与真正的社区获得性感染是不同的。目的：描述培养阳性的社区获得性肺炎（CAP）、卫生保健相关性肺炎（HCAP）、医院获得性肺炎（HAP）和呼吸机相关性肺炎（VAP）患者的微生物学特征和结局。一项基于大型美国住院患者数据库的回顾性队列研究。在2002年1月1日至2003年12月31日期间，共有4,543名肺炎培养阳性患者入住美国59家医院，并在一个大型，美国急症医院多机构数据库（Cardinal Health-Atlas研究数据库; Cardinal Health临床知识服务;马尔伯勒，马萨诸塞州）。主要指标：文化数据（呼吸和血液）、住院死亡率、住院时间（LOS）和医院收费。大约一半的肺炎住院患者患有CAP，并且> 20%患有HCAP。金黄色葡萄球菌是所有肺炎类型中的主要病原体，其在非CAP组中的发生率明显高于CAP组。与HCAP（19.8%）和HAP（18.8%）相关的死亡率相当（p > 0.05），均显著高于CAP（10%，所有p < 0.0001），低于VAP（29.3%，所有p < 0.0001）。平均LOS随肺炎类别而显著变化（按数值递增顺序：CAP、HCAP、HAP和VAP;所有p < 0.0001）。同样，平均住院费用也随肺炎类别而显著变化（按上升值顺序：CAP，HCAP，HAP和VAP;所有p < 0.0001）。金黄色葡萄球菌是所有肺炎的主要病原体，在非CAP肺炎中的发生率更高。与CAP相比，非CAP与更严重的疾病、更高的死亡率、更大的LOS和更高的费用相关。
Context: Traditionally, pneumonia developing in patients outside the hospital is categorized as community acquired, even if these patients have been receiving health care in an outpatient facility. Accumulating evidence suggests that health-care-associated infections are distinct from those that are truly community acquired.Objective: To characterize the microbiology and outcomes among patients with culture-positive community-acquired pneumonia (CAP), health-care-associated pneumonia (HCAP), hospital-acquired pneumonia (HAP), and ventilator-associated pneumonia (VAP).Design and setting: A retrospective cohort study based on a large US inpatient database.Patients: A total of 4,543 patients with culture-positive pneumonia admitted into 59 US hospitals between January 1, 2002, and December 31, 2003, and recorded in a large, multi-institutional database of US acute-care hospitals (Cardinal Health-Atlas Research Database; Cardinal Health Clinical Knowledge Services; Marlborough, MA).Main measures: Culture data (respiratory and blood), in-hospital mortality, length of hospital stay (LOS), and billed hospital charges.Results: Approximately one half of hospitalized patients with pneumonia had CAP, and > 20% had HCAP. Staphylococcus aureus was a major pathogen in all pneumonia types, with its occurrence markedly higher in the non-CAP groups than in the CAP group. Mortality rates associated with HCAP (19.8%) and HAP (18.8%) were comparable (p > 0.05), and both were significantly higher than that for CAP (10%, all p < 0.0001) and lower than that for VAP (29.3%, all p < 0.0001). Mean LOS varied significantly with pneumonia category (in order of ascending values: CAP, HCAP, HAP, and VAP; all p < 0.0001). Similarly, mean hospital charge varied significantly with pneumonia category (in order of ascending value: CAP, HCAP, HAP, and VAP; all p < 0.0001).Conclusions: The present analysis justified HCAP as a new category of pneumonia. S aureus was a major pathogen of all pneumonias with higher rates in non-CAP pneumonias. Compared with CAP, non-CAP was associated with more severe disease, higher mortality rate, greater LOS, and increased cost.