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Analysis of clinical efficacy of different initial antimicrobial treatment in healthcare associated pneumonia patients in emergency department 被引量:4

Analysis of clinical efficacy of different initial antimicrobial treatment in healthcare associated pneumonia patients in emergency department
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摘要 Background Community acquired pneumonia (CAP) is one of the most common infectious disease in emergency department.In 2005 the concept of healthcare associated pneumonia (HCAP) was proposed by the ATS/IDSA guidelines.The clinical features and microbiology of HCAP are different from CAP,however,the initial antimicrobial treatment is still controversial.We aimed to compare the clinical efficacy between HCAP patients treated initially with HCAP guidelineconcordant antimicrobial agents and those with CAP guideline-concordant antimicrobial agents.Methods We conducted a retrospective observational study on HCAP patients who were admitted to emergency department between December 2011 and December 2012.Patients were divided into 2 groups according to their different initial antimicrobial treatment.We compared clinical features,distribution of pathogen,severity,days and spending on intravenous antimicrobial,length and charge of hospitalization and clinical outcomes,and meanwhile analyzed the clinical efficacy as well.Results Of the 125 HCAP patients,55 patients received CAP guideline-concordant antimicrobial agents and 70 received HCAP agents.The major pathogens were Klebsiella pneumoniae,methicillin-resistant staphylococcus aureus (MRSA),Pseudomonas aeruginosa and Escherichia coll The 2 groups were similar at baseline,including old age,comorbidities,Pneumonia Severity Index scores,APACHE scores,and length of intravenous antimicrobial use and hospitalization duration,and in-hospital mortality.Overall efficacy rate occurred in 70.0% of HCAP agent patients and 50.9% of CAP agent patients (P=0.029).Antimicrobial charge and total hospital charge for HCAP agent patients were significantly higher than that for CAP agent patients.Conclusions Initial treatment of HCAP patients in emergency department with HCAP guideline-concordant antimicrobial could increase clinical efficacy rate,as well as antimicrobial charge and total hospital charge,but was not associated with shortening the length of stay,or lowering in-hospital mortality. Background Community acquired pneumonia (CAP) is one of the most common infectious disease in emergency department.In 2005 the concept of healthcare associated pneumonia (HCAP) was proposed by the ATS/IDSA guidelines.The clinical features and microbiology of HCAP are different from CAP,however,the initial antimicrobial treatment is still controversial.We aimed to compare the clinical efficacy between HCAP patients treated initially with HCAP guidelineconcordant antimicrobial agents and those with CAP guideline-concordant antimicrobial agents.Methods We conducted a retrospective observational study on HCAP patients who were admitted to emergency department between December 2011 and December 2012.Patients were divided into 2 groups according to their different initial antimicrobial treatment.We compared clinical features,distribution of pathogen,severity,days and spending on intravenous antimicrobial,length and charge of hospitalization and clinical outcomes,and meanwhile analyzed the clinical efficacy as well.Results Of the 125 HCAP patients,55 patients received CAP guideline-concordant antimicrobial agents and 70 received HCAP agents.The major pathogens were Klebsiella pneumoniae,methicillin-resistant staphylococcus aureus (MRSA),Pseudomonas aeruginosa and Escherichia coll The 2 groups were similar at baseline,including old age,comorbidities,Pneumonia Severity Index scores,APACHE scores,and length of intravenous antimicrobial use and hospitalization duration,and in-hospital mortality.Overall efficacy rate occurred in 70.0% of HCAP agent patients and 50.9% of CAP agent patients (P=0.029).Antimicrobial charge and total hospital charge for HCAP agent patients were significantly higher than that for CAP agent patients.Conclusions Initial treatment of HCAP patients in emergency department with HCAP guideline-concordant antimicrobial could increase clinical efficacy rate,as well as antimicrobial charge and total hospital charge,but was not associated with shortening the length of stay,or lowering in-hospital mortality.
出处 《Chinese Medical Journal》 SCIE CAS CSCD 2014年第10期1814-1819,共6页 中华医学杂志(英文版)
关键词 PNEUMONIA health care drug resistance treatment efficacy pneumonia health care drug resistance treatment efficacy
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  • 1American Thoracic Society, Infectious Disease So.ciety of American. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare- associated pneumonia. Am J Respir Crit Care Med 2005; 171: 388-416.
  • 2Kollef MH, Shorr A, Tabak YP, Gupta V, Liu LZ, Johannes RS. Epidemiology and outcomes of healthcare associated pneumonia results from a large US database of culture-positive pneumonia. Chest 2005; 128: 3854-3862.
  • 3Carratala J, Mykietiuk A, Fernandez-Sabe N, Suurez C, Dorca J, Verdaguer R, et al. Healthcare-associated pneumonia requiring hospital admission epidemiology, antibiotic therapy, and clinical outcomes. Arch Intern Meal 2007; 167: 1393-1399.
  • 4Micek ST, Kollef KE, Reichley RM, Roubinian N, Kollef MH. Health care-associated pneumonia and community-acquired pneumonia a single-center experience. Antimicrob Agents Chemother 2007; 51 : 3568-3573.
  • 5Shindo Y, Sato S, Maruyama E, Ohashi T, Ogawa M, Hashimoto N, et al. Health-care-associated pneumonia among hospitalized patients in a Japanese community hospital. Chest 2009; 135: 633-640.
  • 6Guimaraes C, Lares Santos C, Costa F, Barata F. Pneumonia associated with health care versus community acquired pneumonia: different entities, distinct approaches. Rev Port Pneumo12011; 17: 168-171.
  • 7Sugisaki M, Enomoto T, Shibuya Y, Matsumoto A, Saitoh H, Shingu A, et al. Clinical characteristics of healthcare-associated pneumonia in a public hospital in a metropolitan area of Japan. J Infect Chemother 2012; 18: 352-360.
  • 8Shorr AF, Zilberberg MD, Micek ST, Kollef MH. Prediction of infection due to antibiotic-resistant bacteria by select risk factors for health care-associated pneumonia. Arch Intern Med 2008; 168: 2205-2210.
  • 9Schreiber ME Chan CM, Shorr AF. Resistant pathogens in non- nosocomial pneumonia and respiratory failure: is it time to refine the definition of health-care-associated pneumonia? Chest 2010; 137: 1283-1288.
  • 10Ewig S, Welte T, Torres A. Is healthcare-associated pneumonia a distinct entity needing specific therapy? Curt Opin Infect Dis 2012; 25: 166-175.

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