| アブストラクト | BACKGROUND AND OBJECTIVE: The 2019 ATS/ADSA guidelines for adult community-acquired pneumonia (CAP) eliminated healthcare-associated pneumonia (HCAP) and considered it to be a form of CAP. This concept, however, was based on studies with relatively small sample sizes. METHODS: We investigated the risk factors of 30-day mortality, and methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa infections in patients with pneumonia coming from the community using the Diagnosis Procedure Combination database, a nationwide discharge database of acute care hospitals. Furthermore, we compared these factors between CAP and HCAP. RESULTS: A total of 272,337 patients aged >/=20 years with pneumonia were grouped into 145,082 CAP patients and 127,255 HCAP patients. The 30-day mortality rate (8.9 % vs.3.3 %), MRSA infection (2.4 % vs. 1.4 %), and Pseudomonas aeruginosa infection (1.6 % vs. 1.0 %) were significantly higher in HCAP than in CAP patients. Multivariable logistic regression analysis showed that 12 of 13 identified predictors of mortality (i.e., high age, male, underweight, non-ambulatory status, bedsore, dehydration, respiratory failure, consciousness disturbance, hypotension, admitted in critical care, comorbidity of heart failure, and chronic obstructive pulmonary disease) were identical in CAP and HCAP patients. Similarly, five of six distinct risk factors for MRSA infection, and three of three for Pseudomonas aeruginosa infection were identical between the patients. CONCLUSION: The risk factors for mortality and MRSA or Pseudomonas aeruginosa infection were almost identical in patients with CAP and HCAP. The assessment of individual risk factors for mortality and MRSA or Pseudomonas aeruginosa infection in CAP and abandoning categorization as HCAP can improve and simplify empiric therapy. |
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| 投稿者 | Ukai, Tomohiko; Maruyama, Takaya; Tomioka, Shinichi; Fukui, Takumi; Matsuda, Shinya; Fushimi, Kiyohide; Iso, Hiroyasu |
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| 組織名 | Department of Epidemiology and Clinical Research, The Research Institute of;Tuberculosis, 3-1-24, Matsuyama, Kiyose City, Tokyo, 204-8553, Japan.;Division of Public Health, Osaka Institute of Public Health, 1-3-69 Nakamichi,;Higashinari-ku, Osaka, Osaka 537-0025, Japan.;Mie Prefectural Ichishi Hospital, Tsu, Mie, 513-3133, Japan.;Call Medical Clinic Fukuoka, Munakata, Fukuoka 811-3516, Japan.;Department of Preventive Medicine and Community Health, School of Medicine,;University of Occupational and Environmental Health, 1-1, Iseigaoka,;Yahatanishiku, Kitakyushu, 807-8555, Japan.;Department of Health Policy and Informatics, Tokyo Medical and Dental University,;1-5-45, Yushima, Bunkyoku, Tokyo, 113-8510, Japan.;Institute for Global Health Policy Research, National Center for Global Health;and Medicine, 1-21-1 Toyama Shinjuku-ku, Tokyo, 162-8655, Japan. |
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