A multicenter comparative study of emergency healthcare-associated pneumonia and community-acquired pneumonia
10.3760/cma.j.issn.1671-0282.2021.05.012
- VernacularTitle:急诊医疗保健相关性肺炎与社区获得性肺炎的多中心比较研究
- Author:
Ming ZHOU
;
Wenqing JI
;
Yan LIU
;
Wei GUO
;
Shubin GUO
;
Bin ZHAO
- From:
Chinese Journal of Emergency Medicine
2021;30(5):576-581
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To explore the differences between emergency healthcare-associated pneumonia (HCAP) and community-acquired pneumonia (CAP), to analyze whether HCAP is a relatively independent type pneumonia in the emergency department in China.Methods:Clinical data of HCAP and CAP patients admitted to the emergency department of Beijing Tiantan Hospital, Beijing Chaoyang Hospital of Capital Medical University and Huilongguan Hospital from September 2018 to May 2019 were retrospectively analyzed. General information of the patients, types of basic diseases, laboratory examination within 24 h of admission, etiological examination results, empirical anti-infection treatment plan, mechanical ventilation and clinical outcome were collected. The pneumonia severity index (PSI) was used to assess the pneumonia severity. The measurement data were expressed as mean ± standard deviation for t test, and the counting data were performed by χ 2 test. A P<0.05 indicated statistical difference. Results:One hundred and five HCAP patients and 105 CAP patients were collected. The number of HCAP combined with two or more basic diseases was higher than that of the CAP group. There were statistically significant differences between the two groups in white blood cell count, mean hemoglobin and blood lactic acid level.The PSI score of the HCAP group was higher than that of the CAP group (134.0±26.3 vs 113.0±16.34). The PSI score grade IV of the HCAP group was lower than that of the CAP group, while the PSI score grade V of the HCAP group was higher than that of the CAP group, with statistically significant differences ( P<0.05). In the HCAP group, 73 strains (69.52%) and 55 strains (52.38%) of multi-drug resistant strains were isolated. Acinetobacter baumannii and Streptococcus pneumoniae, Klebsiella pneumoniae and Escherichia coli in the HCAP group were more than those in the CAP group. The drug resistance rate of pseudomonas aeruginosa to imipenem in the HCAP group was higher than that in the CAP group (22.2% vs 10.0%); the drug resistance rate of Acinetobacter baumannii to cefoperazone/sulbactam was lower than that in the CAP group (27.3% vs 54.5%); the drug resistance rate of Pseudomonas aeruginosa to Meropenem was lower than that in the CAP group (45.5% vs 72.7%). The proportion of carbapenems in the initial empirical anti-infection treatment in the HCAP group was higher than that in the CAP group (21.00% vs 10.48%), and the difference was statistically significant. The ratio of invasive mechanical ventilation and the fatality rate in the HCAP group were higher than those in the CAP group (21.00% vs 7.62%, 21.00% vs 8.57%; both P<0.05). Conclusions:HCAP patients in emergency department are complicated with a variety of basic diseases, high drug resistance rate of pathogenic bacteria, and more advanced drugs are required for initial empirical anti-infection treatment, high proportion of mechanical ventilation, and high fatality rate. HCAP is a relatively independent category of pneumonia in emergency in China.
