Low incidence of multidrug-resistant organisms in patients with healthcare-associated pneumonia requiring hospitalization.
入院が必要な医療ケア関連肺炎患者における
多剤耐性微生物の低い発生率
Clin Microbiol Infect. 2011 Nov;17(11):1659-65
Abstract 抄録
Healthcare-associated pneumonia (HCAP) includes a broad spectrum of patients who acquire pneumonia through outpatient contact with the health system.
医療ケア関連肺炎(HCAP)は、
医療機関での外来患者との接触を介して
肺炎にかかる広範囲の患者を含む

Although limited prospective data exist, it has been suggested that all patients with HCAP should receive empirical therapy with a multidrug regimen directed against drug-resistant organisms.
制限のある前向き研究のデータが存在するが、
それらはHCAPの全ての患者は薬剤耐性微生物に
対して多剤レジメンのエンピリック治療(経験的な抗菌剤治療)を
受けるべきだと示唆している

We aimed to determine the differences in aetiology and outcomes between HCAP groups and a community-acquired pneumonia (CAP) group, and to assess the presence of antibiotic-resistant bacteria.
我々の目的は、HCAP群と市中肺炎(CAP)群の
間の病因と転帰における差を決定し
抗菌剤耐性細菌の存在の評価をすることだった

All consecutive non-immunocompromised adults hospitalized with pneumonia were prospectively included from 2001 to 2009.
2001年から2009年までの肺炎で入院した全ての継続的に免疫不全でない成人患者が
前向きに含まれた

Patients who had had recent contact with the health system through nursing homes, home healthcare programmes, haemodialysis clinics or prior hospitalization were considered to have HCAP.
老人ホーム、在宅医療プログラム、透析クリニック
または以前の入院を介して医療機関への最近の接触
がある肺炎患者はHCAP(医療ケア関連肺炎)と考えた

A total of 2245 patients with pneumonia were hospitalized through the emergency room, of whom 577 (25.7%) had HCAP.
総数2245人の肺炎患者は、救急処置室を介して入院しそのうち577人(25.7%)がHCAPだった

Significant differences in causative pathogens were found between groups.
グループの間に起因菌において有意な差がみられた

Antibiotic-resistant organisms, including methicillin-resistant Staphylococcus aureus, resistant strains of Pseudomonas aeruginosa, and extended-spectrum β-lactamase-producing Enterobacteriaceae, were scarce in all groups.
メチシリン耐性黄色ブドウ球菌、緑膿菌の耐性株、基質特異性拡張型βラクタマーゼ産生腸内細菌科を含む抗菌剤耐性微生物は、全グループで少なかった

In contrast, aspiration pneumonia was particularly frequent.
対照的に、誤嚥性肺炎は特に頻度が高かった

No differences were found regarding inappropriate initial empirical antibiotic therapy between groups.
不適切な初期エムピリック抗菌剤治療(経験的抗菌剤治療)に関しては
グループ間で差はみられなかった

Overall mortality was higher in patients who attended a hospital or haemodialysis clinic or received intravenous chemotherapy in the 30 days before pneumonia, and among patients who resided in a nursing home or long-term-care facility.
全死亡率は、肺炎発症前の30日以内に、
病院または透析クリニックへ通った患者、または
点滴の化学療法を受けた患者、と、老人ホームまたは介護施設に住む患者の間で、より高かった

In conclusion, most HCAP patients could be treated in the same way as patients with CAP, after carefully ruling out the presence of aspiration pneumonia.
結論として、誤嚥性肺炎の存在を慎重に除外後
ほとんどのHCAP患者はCAP患者と同じ方法で
治療が可能だった