Tuberkuloz ve Toraks-Tuberculosis and Thorax最新文献

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Clinical characteristics and outcome of healthcare associated pneumonia in Turkey. 土耳其医疗保健相关肺炎的临床特征和结果。

IF 1.1 Q4 RESPIRATORY SYSTEM

Tuberkuloz ve Toraks-Tuberculosis and Thorax

Pub Date : 2016-09-01

Canan Gündüz, Mehmet Sezai Taşbakan, Abdullah Sayıner, Aykut Çilli, Oğuz Kılınç, Ayşın Şakar Coşkun

Introduction: Pneumonia in cases with preceding hospitalization, hemodialysis, intravenous therapy, wound care, or chemotherapy within the prior 30 days and residence in nursing homes are defined as healthcare associated pneumonia (HCAP). The aim of this study was to compare the demographic and laboratory data, isolated causative agents and prognosis of patients with community-acquired pneumonia (CAP) and HCAP in a large population in Turkey.

Materials and methods: The data of 785 cases (average age 65.3 ± 16.4, 530 male) registered to Turkish Thoracic Society Respiratory Infections Study Group CAP database (TURCAP) were examined. The demographic data, clinical history, pneumonia severity scores (PSI), laboratory and radiologic findings of the CAP and HCAP patients were compared.

Result: Out of 785 cases, 207 (26.4%) were diagnosed with HCAP and 578 (73.6%) with CAP. Among HCAP cases, 140/207 (67.6%) had preceding hospitalization in the last 90 days, 28/207 (13.5%) were on a hemodialysis program during the previous 30 days and 22/207 (10.6%) were staying in nursing homes. Patients with HCAP more frequently had comorbidities (93.2% vs. 81.6%; p= 0.001) and higher PSI scores (103.9 ± 37.2 vs. 94.6 ± 35.4; p= 0.002) compared to patients with CAP. A causative microorganism was isolated in only 12.1% (70/578) of CAP and 14.5% (30/207) of HCAP patients. The length of stay in hospital was higher in HCAP than CAP (8.6 ± 5.5 vs. 7.5 ± 6.1 days, p= 0.03); however the rates of treatment failure, intensive care unit admission and mortality were similar.

Conclusions: In comparison to CAP, HCAP patients tend to have more severe disease, despite have no difference in mortality. The current criteria for HCAP do not predict worse clinical outcomes. Further work is required to define local risk factors for multidrug-resistant pathogens.

引言：在过去30天内住院、血液透析、静脉注射治疗、伤口护理或化疗并居住在疗养院的肺炎被定义为医疗相关肺炎（HCAP）。本研究的目的是比较土耳其大量人群中社区获得性肺炎（CAP）和HCAP患者的人口统计学和实验室数据、分离的病原体和预后。材料和方法：对土耳其胸科学会呼吸道感染研究组CAP数据库（TURCAP）登记的785例病例（平均年龄65.3±16.4530，男性）的数据进行检查。比较CAP和HCAP患者的人口统计学数据、临床病史、肺炎严重程度评分（PSI）、实验室和放射学检查结果。结果：785例中，207例（26.4%）诊断为HCAP，578例（73.6%）诊断为CAP。在HCAP病例中，140/207（67.6%）在过去90天内曾住院，28/207（13.5%）在过去30天内接受血液透析，22/207（10.6%）住在疗养院。与CAP患者相比，HCAP患者更常见的合并症（93.2%对81.6%；p=0.001）和更高的PSI评分（103.9±37.2对94.6±35.4；p=0.002）。仅12.1%（70/578）的CAP和14.5%（30/207）的HCAP患者中分离到致病微生物。HCAP的住院时间高于CAP（8.6±5.5 vs.7.5±6.1天，p=0.03）；然而，治疗失败率、重症监护室入院率和死亡率相似。结论：与CAP相比，HCAP患者的疾病往往更严重，尽管死亡率没有差异。目前的HCAP标准并不能预测更糟糕的临床结果。需要进一步的工作来确定耐多药病原体的局部风险因素。

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