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首页> 外文期刊>Infection control and hospital epidemiology >Outcomes of Patients with Healthcare-Associated -Pneumonia: Worse Disease or Sicker Patients?
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Outcomes of Patients with Healthcare-Associated -Pneumonia: Worse Disease or Sicker Patients?

机译：医疗保健相关性肺炎患者的结局：病情较重或病情较重的患者？

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background. Healthcare-associated pneumonia (HCAP) is an entity distinct from community-acquired pneumonia (CAP). HCAP has a higher case-fatality rate, due either to HCAP organisms or to the health status of HCAP patients. The contribution of HCAP criteria to case-fatality rate is unknown.methods. We conducted a retrospective review of adult patients admitted with a diagnosis of pneumonia from July 2007 through November 2011 to 491 US hospitals. HCAP was denned as having at least 1 of the following: prior hospitalization within 90 days, hemodialysis, admission from a skilled nursing facility, or immune suppression. We compared characteristics of patients with CAP and patients with HCAP and explored the contribution of HCAP criteria to case-fatality rate in a hierarchical generalized linear model.results. Of 436,483 patients hospitalized with pneumonia, 149,963 (34.4%) had HCAP. Compared to CAP patients, HCAP patients were older, had more comorbidities, and were more likely to require intensive care unit (ICU) care. In-hospital case-fatality rate was higher among patients with HCAP, compared to those with CAP (11.1% vs 5.1%, P < .001). After adjustment for demographics, comorbidities, presence of other infections, early ICU admission, chronic and acute medications, early tests and therapies, and length of stay, HCAP remained associated with increased case-fatality rate (odds ratio [OR], 1.35 [95% confidence interval (CI), 1.32-1.39]); odds of death increased for each additional HCAP criterion (OR [95% CI]: 1 criterion, 1.27 [1.23-1.31], 2 criteria, 1.55 [1.49-1.62], and 3 or more criteria, 1.88 [1.72-2.06]).conclusions. After adjustment for differences in patient characteristics, HCAP was associated with greater case-fatality rate than CAP. This difference may be due to HCAP organisms or to HCAP criteria themselves.
机译：背景。医疗保健相关性肺炎（HCAP）是不同于社区获得性肺炎（CAP）的实体。由于HCAP微生物或HCAP患者的健康状况，HCAP的病死率更高。 HCAP标准对病死率的贡献未知。我们对2007年7月至2011年11月间被确诊为肺炎的成年患者进行了回顾性审查，涉及美国491所医院。 HCAP被确定为具有以下至少一种：90天内的先前住院治疗，血液透析，从专业的护理机构入院或免疫抑制。我们比较了CAP患者和HCAP患者的特征，并在分层广义线性模型中探讨了HCAP标准对病死率的影响。在436,483名肺炎住院患者中，有149,963名（34.4％）患有HCAP。与CAP患者相比，HCAP患者年龄更大，合并症更多，需要重症监护病房（ICU）的可能性更高。 HCAP患者的住院病死率高于CAP患者（11.1％vs 5.1％，P <.001）。在调整了人口统计学，合并症，其他感染的存在，ICU的早期入院，慢性和急性药物治疗，早期测试和疗法以及住院时间后，HCAP仍然与病死率增加相关（优势比[OR]为1.35 [95] ％置信区间（CI），1.32-1.39]）;每增加一个HCAP标准，死亡几率就会增加（或[95％CI]：1个标准，1.27 [1.23-1.31]，2个标准，1.55 [1.49-1.62]和3个或更多标准，1.88 [1.72-2.06]）结论。调整患者特征差异后，HCAP的病死率高于CAP。这种差异可能是由于HCAP生物或HCAP标准本身造成的。

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