医院感染性肺炎流行病学，抗生素治疗和临床预后：UK的队列研究

蓝鱼o_0

Epidemiology, Antibiotic Therapy, and Clinical Outcomes in Health Care–Associated Pneumonia: A UK Cohort Study

James D. Chalmers,1 Joanne K. Taylor,1 Aran Singanayagam,2 Gillian B. Fleming,1 Ahsan R. Akram,2 Pallavi Mandal,2
Gourab Choudhury,2 and Adam T. Hill1,2
1MRC Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, and 2Department of Respiratory Medicine, Royal
Infirmary of Edinburgh, Edinburgh, United Kingdom
Background. The recently introduced concept of health care–associated pneumonia (HCAP), referring to
patients with frequent healthcare contacts and at higher risk of contracting resistant pathogens, is controversial.
Methods. This prospective observational study recorded the clinical features, microbiology, and outcomes in
a UK cohort of hospitalized patients with pneumonia. The primary outcome was 30-day mortality. Logistic
regression was used to adjust for confounders when determining the impact of HCAP on clinical outcomes.
Results. A total of 20.5% of patients met the HCAP criteria. HCAP patients were older than patients with
community-acquired pneumonia (CAP) (median 76 y, IQR 65–83 vs 65 y, IQR 48–77; P , .0001) and more
frequently had major comorbidities (62.1% vs 45.2%; P , .0001). Patients with HCAP had higher initial severity
compared to CAP patients (Pneumonia Severity Index, mean 3.7 [SD 1.1] vs mean 3.1 [SD 1.3]; P , .0001) but also
worse functional status using the Eastern Cooperative Oncology Group scale (mean 2.4 [SD 1.44] vs mean 1.4 [SD
1.13]; P , .0001) and more frequently had treatment restrictions such as do not resuscitate orders (59.9% vs 29.8%;
P , .0001). Consequently mortality was increased (odds ratio [OR] 2.15 [1.44–3.22]; P 5 .002) in HCAP patients
on univariate analysis. Multivariate analysis suggested this relationship was primarily due to confounders rather
than a higher frequency of treatment failure due to resistant organisms (adjusted OR .97 [.61–1.55]; P 5 .9). The
frequencies of Pseudomonas aeruginosa, methicillin-resistant Staphylococcus aureus, and Gram-negative Enterobacteriaceae
were low in both cohorts.
Conclusions. HCAP is common in the United Kingdom and is associated with a high mortality. This increased
mortality was primarily related to underlying patient-related factors rather than the presence of antibiotic-resistant
pathogens. This study did not establish a clear indication to change prescribing practices in a UK cohort.