老年人医疗保健相关性肺炎与社区获得性肺炎临床特点的差异

The differences in clinical characteristics between health care associated pneumonia and community acquired pneumonia in elderly patients

目的比较老年人医疗保健相关性肺炎（healthcareassociatedpneumonia，HcAP）与社区获得性肺炎（communityacquiredpneumonia，cAP）临床特点的差异。方法回顾性分析了282例老年肺炎患者的临床资料，比较HCAP患者与cAP患者在流行病学、病原学、治疗及预后方面的差异。结果282例老年肺炎患者分为HCAP组69例（25．5％）及CAP组213例（75．5％）。HCAP组慢性阻塞性肺疾病及脑血管疾病分别为49例（71．0％）和36例（52．20A），较CAP组93例（43．7％）和57例（26．8％）多见（y=-15．59、15．23，均P〈0．001）；HCAP组患者铜绿假单胞菌、金黄色葡萄球菌及鲍曼不动杆菌感染分别为29例（51．8V00）、19例（34．0％）、18（32．1％），比CAP组感染26例（27．7％）、12例（12．8％）、8例（8．5％）多见（7。一8．79、9．58、13．67，均P〈0．05），而CAP组肺炎链球菌感染38例（40．4％），较HCAP组4例（7．1％）多见（x2=19．28，P〈0．001）；HCAP组经验性抗感染治疗失败率34．8％（24例）及住院病死率27．5％（19例），均高于CAP组17．3％（37例）、13．6％（29例）（x2=9．32、7．15，均P〈0．05）。结论在老年人中，HCAP较CAP病原复杂、耐药性强、病情严重且治疗困难，应进一步加强老年人HCAP的诊治研究。

Objective To reveal the differences in clinical characteristics between health care associated pneumonia （HCAP） and community acquired pneumonia （CAP） in elderly patients. Methods A total of 282 elderly patients were evaluated, including 69 patients with HCAP （25.5%） and 213 with CAP （75.5%）. A retrospective observational study was conducted. The baseline characteristics, comorbidities, pathogen distribution, antibiotics, and clinical outcomes between HCAP and CAP patients were compared. Results The incidence of chronic obstructive pulmonary diseases and cerebrovascular diseases were higher in HCAP group （49 cases, 71.0%; 36 cases, 52.2% ） than in CAP group （93 cases, 43.7% ; 57 cases, 26.8~/00） （）2 = 15. 598, 15. 229, all P〈 0. 001）. The infection of Pseudomonas aeruginosa （29 cases, 51.8%）, Staphylococcus aureus （19 cases, 34.0%） and Acinetobacter baumannii （18 cases, 32. 1%） in HCAP group were more than in CAP group 2（26 cases, 27.7%//00）, （12 cases, 2.8%）, （8 cases, 8.5%）, （Z2 =8.796, 9.586, 13. 678, all P〈0.05）3, respectively. While the infection of Streptococcus pneumoniae （38 cases, 40.40//oo） in CAP group was much more than in HCAP group （4 cases, 7.1%） （ x2 = 19. 283, P〈 0.001）. Initial inappropriate antibiotics treatment failure was more frequent in HCAP group （24 cases, 34.8%） than in CAP group （37 cases, 17.3%）（X2=9.321, P〈0.05）. The mortality was higher in HCAP group （19 cases, 27.5%） than in CAP group （29 cases, 13.6%）（x2 =7. 151, P〈 0.05）. Conclusions HCAP should be distinguished from CAP in elderly, which is helpful to choose appropriate empirical anti-infective regimen and improve the effect of HCAP treatment.