Microbial aetiology of healthcare associated pneumonia in Spain: a prospective, multicentre, case-control study
Microbial aetiology of healthcare associated pneumonia in Spain: a prospective, multicentre, case-control study
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DOI：
10.1136/thoraxjnl-2013-203828
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发表时间：
2013-11-01
期刊：
影响因子：
10
通讯作者：
Rello, Jordi
中科院分区：
文献类型：
--
作者：
Polverino, Eva;Torres, Antoni;Rello, Jordi
医疗保健相关性肺炎（HCAP）实际上被认为是医院获得性肺炎的一个亚组，因为在美国报告了多药耐药病原体的高风险。因此，目前美国胸科学会/美国传染病学会指南建议对HCAP进行医院抗生素治疗。方法我们在西班牙进行了一项前瞻性多中心病例对照研究，比较了HCAP和社区获得性肺炎（CAP）患者的临床表现、结局和微生物病原学，年龄（10岁）、性别和住院时间（10周）相匹配。从2008年6月起，共招募238例病例和238例对照。HCAP病例显示出显著更多的合并症（包括吞咽困难），前一个月内既往抗生素使用频率更高，肺炎严重程度评分更高，临床状态（Charslon和Barthel评分）更差。虽然两组之间的微生物病因没有差异，（HCAP和CAP：肺炎链球菌：51% vs 55%;病毒：22% vs 12%;军团菌：4% vs 9%;革兰氏阴性杆菌：5% vs 4%;铜绿假单胞菌：4% vs 1%），HCAP患者的死亡率更低（1个月：HCAP，12%; CAP 5%; 1年：HCAP，24%; CAP，9%），住院时间（9天vs 7天），1个月治疗失败（5.5% vs 1.5%）和再入院率（18% vs 11%）（p
Introduction Healthcare-associated pneumonia (HCAP) is actually considered a subgroup of hospital-acquired pneumonia due to the reported high risk of multidrug-resistant pathogens in the USA. Therefore, current American Thoracic Society/Infectious Diseases Society of America guidelines suggest a nosocomial antibiotic treatment for HCAP. Unfortunately, the scientific evidence supporting this is contradictory.Methods We conducted a prospective multicentre case-control study in Spain, comparing clinical presentation, outcomes and microbial aetiology of HCAP and community-acquired pneumonia (CAP) patients matched by age (10years), gender and period of admission (10weeks).Results 476 patients (238 cases, 238 controls) were recruited for 2years from June 2008. HCAP cases showed significantly more comorbidities (including dysphagia), higher frequency of previous antibiotic use in the preceding month, higher pneumonia severity score and worse clinical status (Charslon and Barthel scores). While microbial aetiology did not differ between the two groups (HCAP and CAP: Streptococcuspneumoniae: 51% vs 55%; viruses: 22% vs 12%; Legionella: 4% vs 9%; Gram-negative bacilli: 5% vs 4%; Pseudomonas aeruginosa: 4% vs 1%), HCAP patients showed worse mortality rates (1-month: HCAP, 12%; CAP 5%; 1-year: HCAP, 24%; CAP, 9%), length of hospital stay (9 vs 7days), 1-month treatment failure (5.5% vs 1.5%) and readmission rate (18% vs 11%) (p