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【科普】医疗相关肺炎重于社区获得性肺炎
January 7, 2009 — Healthcare-associated pneumonia should be considered a distinct subset of pneumonia that causes more severe disease, longer hospitalization, and higher mortality rates than community-acquired pneumonia, according to the results of a prospective cohort study published in the January 6 issue of the Annals of Internal Medicine.
"Traditionally, pneumonia has been classified as either community- or hospital-acquired," write Mario Venditti, MD, from the University of Rome in Italy, and colleagues from the Study Group of the Italian Society of Internal Medicine. "Although only limited data are available, health care–associated pneumonia has been recently proposed as a new category of respiratory infection. 'Health care–associated pneumonia' refers to pneumonia in patients who have recently been hospitalized, had hemodialysis, or received intravenous chemotherapy or reside in a nursing home or long-term care facility."
The goal of this study was to determine the epidemiology and outcome of community-acquired, healthcare-associated, and hospital-acquired pneumonia in adults hospitalized in internal medicine wards at 55 hospitals in Italy with a total of 1941 beds. Among 362 patients hospitalized with pneumonia during two 1-week surveillance periods, the investigators classified cases of radiologically and clinically evaluated pneumonia as community-acquired, healthcare-associated, or hospital-acquired and compared clinical features in these 3 groups.
Community-acquired pneumonia was present in 61.6% of the 362 patients, healthcare-associated pneumonia in 24.9%, and hospital-acquired pneumonia in 13.5%. Compared with patients with community-acquired pneumonia, patients with healthcare-associated pneumonia had higher mean Sequential Organ Failure Assessment scores (3.0 vs 2.0), were more likely to be malnourished (11.1% vs 4.5%), and had more frequent bilateral (34.4% vs 19.7%) and multilobar (27.8% vs 21.5%) disease on chest X-ray.
Patients with healthcare-associated pneumonia also had higher fatality rates (17.8% [95% confidence interval (CI), 10.6% – 24.9%] vs 6.7% [95% CI, 2.9% – 10.5%]) and longer mean hospital stay (18.7 days [95% CI, 15.9 – 21.5 days] vs 14.7 days [95% CI, 13.4 – 15.9 days]).
Factors independently associated with increased intrahospital mortality, based on logistic regression analysis, were depressed level of consciousness (odds ratio [OR], 3.2; 95% CI, 1.06 – 9.8), leukopenia (OR, 6.2; 95% CI, 1.01 – 37.6), and use of empirical antibiotic therapy not recommended by international guidelines (OR, 6.4; 95% CI, 2.3 – 17.6).
"Health care–associated pneumonia should be considered a distinct subset of pneumonia associated with more severe disease, longer hospital stay, and higher mortality rates," the study authors write. "Physicians should differentiate between patients with health care–associated pneumonia and those with community-acquired pneumonia and provide more appropriate initial antibiotic therapy."
Limitations of this study were the relatively small number of patients with healthcare-associated pneumonia, heterogeneity in microbiological evaluations, and lack of generalizability to patients treated as outpatients.
"The selection of empirical antibiotics for health care–associated pneumonia should include coverage of methicillin-resistant S[taphylococcus] Aureus and multidrug-resistant gram-negative rods (such as linezolid or glycopeptides plus an antipseudomonal beta-lactam), as recommended by the consensus of Infectious Diseases Society of America experts," the study authors conclude.
医疗相关肺炎重于社区获得性肺炎
2009年1月7日-根据1月6日内科学年鉴公布的一项前瞻性队列研究的结果，医疗相关性肺炎应被视为肺炎的一个独特亚型，较社区获得性肺炎病情更严重、住院更长和死亡率更高。
意大利罗马大学Mario Venditti博士和他的意大利内科学会研究小组同事认为，“传统意义上肺炎分为社区或医院获得性，虽然只有有限的数据，最近提出将医疗相关性肺炎作为一类新的呼吸道感染。医疗相关性肺炎是指近期住院治疗、血液透析或接受静脉化疗或住在养老院或长期护理机构患者发生的肺炎。”
本研究调查意大利55家医院内科病房共计1941张病床的住院成人确定社区获得、医疗相关性和医院获得性肺炎流行病学和后果，对362例肺炎住院患者进行了两个为期一周的监测，研究者根据X线及临床评估将肺炎病例归类为社区获得、医疗相关性或医院获得性，比较三组病人的临床特征。
362例肺炎社区获得性肺炎占61.6%、医疗相关性肺炎占24.9%、医院获得性肺炎占13.5%。与社区获得性肺炎患者比较，医疗相关性肺炎病人序贯性器官衰竭评估分数均值较高(3.0 vs 2.0)、营养不良比率更高(11.1% vs 4.5%)且胸部X线显示双侧(34.4% vs 19.7%)、多叶(27.8% vs 21.5%)病变更常见。
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作者:admin@医学,生命科学 2011-02-25 05:11
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