| Objective: Comparing health care-associated pneumonia (HCAP) withcommunity-acquired pneumonia (CAP) in respiratory intensive care unit(RICU) on onset condition, clinical features, laboratory data, pathogendistribution, severity of disease, initial antibiotics selection, and clinicaloutcomes and so on, to comprehend the epidemiological characteristics of theRICU patients with HCAP, to provide evidence for selection ofantimicrobial drugs, to improve diagnosis and treatment regimen of HCAP,and ultimately to improve the treatment success rate of HCAP.Methods: The patients with nonnosocomial pneumonia admitted to thehospital respiratory intensive care unit since Dec,2009to Nov,2011wereenrolled. According to the diagnostic criteria of HCAP, that is, HCAP includesany patient who was hospitalized in a hospital for two or more days withinpast90days; received long term home care or infusion therapy; receivedchemotherapy or immunosuppressant therapy within the past one month;received intravenous antibiotic therapy within the past30days; or receivedtreatment at outpatient, infusion room or hemodialysis center, all the patientswere divided into HCAP and CAP. In this retrospective study, the clinical dataof the cases were collected, including sexes, age, underlying diseases, clinicalfeatures, laboratory data, etiology, the application of antibiotics, treatmentcosts and outcomes, and so on. Etiological sources include qualified sputumsamples, serum samples and hydrothorax. Specimens to be submitted andprocessed within one hour were taken within48hours after admission. Inaddition, to the patients received intravenous antibiotic therapy at most48hours before admitted to our hospital, antibiotics used when admitted to ourhospital would be as the initial antibiotics. We analyzed the information aboveto compare the epidemiology characteristics between the two groups.Results: A total of78cases met the criteria of nonnosocomial pneumonia among210cases with pneumonia who were admitted to ICU and wereanalyzed in the present study. Among these patients, there were37cases(accounting for47.44%) with HCAP and41cases with CAP.(1) the incidenceof diseases: Sex composition was not different between the two groups ofpatients (P>0.05), but the age difference, the median of74.0and57.0respectively, was statistically significant by rank sum test analysis (P<0.05).85.90%of the78patients had underlying diseases. HCAP patients of whichaccounted for100%, significantly higher than that of CAP patients (73.17%,P<0.01). Among the underlying diseases, cerebrovascular disease is morecommon in HCAP patients (43.24%), and was statistically significantcompared to CAP, and the other underlying diseases were not significantlydifferent. Based on the diagnostic criteria of HCAP,37cases of HCAP patientswere distributed as follows: over the past90days13cases (35.14%) hadhospitalization history;18cases (48.65%) received long-term home care andinfusion therapy;10cases (27.03%) received a chemotherapy orimmunosuppressant treatment; in the past one month2cases (5.41%) receivedintravenous antibiotics, within30days of4cases (10.81%) received treatmentin the outpatient, infusion room or dialysis centers.10cases (27.03%) meettwo or more criteria.(2) Clinical features and laboratory data: main clinicalsymptoms of the two group of patients are fever, cough, expectoration,dyspnea and chest tightness, consciousness and gastrointestinal symptoms arethe most frequent extrapulmonary manifestations, and the main signs arecyanosis and lung dry or moist rales. HCAP is similar to CAP in clinicalfeatures except that abdominal tenderness is not common for HCAP. Thelaboratory findings, including white blood cell count and serum albumin levels,were similar between the two groups. However, oxygenation index was low inHCAP but not statistically significant compared to CAP.(3) Pathogendistribution: Acinetobacter baumannii was the most common pathogen in thetwo groups. In addition to this, pseudomonas aeruginosa and candida albicanswere detected more frequently in patients with HCAP. Conversely, aspergilluswas more frequently isolated from patients with CAP.(4) Disease severity: The CURB-65and APACHE Ⅱ scores of patients with HCAP weresignificantly higher than those of patients with CAP. And severely ill patientswith HCAP are more than those with CAP according to CUEB-65by whichtwo groups of patients were divided into different subgroups.(5) Initialantibiotics therapy and clinical prognosis (If aspergillus is an importantpathogen of CAP, The initial choice of antibiotics may include those usedbefore admission): Patients with HCAP and CAP generally received antibioticmonotherapy, especially with β-lactamase inhibitor, carbapenems,cephalosporins and semisynthetic penicillins as the initial treatment.β-lactamase inhibitor was the most common among them. Combinationtherapy was also generally used in patients with HCAP and CAP.Quinolones were used as combined antibiotics with anyone of the antibioticsused in the monotherapy apart from semisynthetic penicillins. HCAP patientsfrom the point of view of total duration of hospitalization and ICU haverelatively long hospital stay, but the result was not significantly different.and there is no difference in hospitalization costs. HCAP patients who appliedinvasive ventilator with more serious condition were statistically significantlymore than CAP patients. Invasive and non-invasive ventilation time showedno differences. HCAP patients’ cure and improvement rate (43.24%) waslower compared to that of CAP patients (52.22%), but there was no significantdifference (P>0.05). Mortality was almost the same (18.92%vs12.20%, P>0.05).Conclusions: Patients with severe HCAP were significantly older andhad more severe disease than those with CAP. Clinical features of the twogroups were similar, including both pulmonary and extrapulmonarymanifestations. Pathogenic characteristics of HCAP are close to HAP. Sotherapeutic regimen for HCAP should refer to the HAP and consider MDRpathogens. |
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