西班牙的study，覺得跟台灣一樣-HCAP的人反覆住院，多重疾患，而且sign DNR

Factors Related to Mortality in Healthcare-Associated Pneumonia

Excess mortality in patients with HCAP was found to be related to age, comorbidities, and decisions to limit therapeutic interventions.

The recently introduced concept of healthcare-associated pneumonia (HCAP) has created a lot of controversy. Research has shown that, among pneumonia patients, those who have had recent or repeated contact with healthcare institutions exhibit a different spectrum of pathogens and have worse outcomes than those with no such contact. Are the worse outcomes related more to patient characteristics or to the effects of different pathogens with higher resistance rates?

To find out, researchers in Spain conducted a prospective cohort study involving 228 adults with bacteremic pneumococcal pneumonia between January 1999 and June 2007. Forty-four cases were classified as HCAP, and 184 as community-acquired pneumonia (CAP). Among the patients with HCAP, 25 (57%) had been hospitalized during the preceding 90 days; 16 (39%) were admitted from long-term care facilities.

Compared to patients with CAP, those with HCAP were more likely to present with baseline comorbidities (84% vs. 60%; P<0.01) and had more-severe illness overall, as reflected by higher Charlson and Pneumonia Severity index scores. In addition, patients with HCAP were significantly older (median age, 77 vs. 68), were more likely to have medical orders limiting therapeutic interventions (34% vs. 4%; P<0.001),>P<0.05),>

The HCAP cohort had a higher 30-day mortality rate (30% vs. 8%; P<0.001)>2/FiO2 ratio <250,>

Comment: Focusing on pneumococcal pneumonia in this study eliminated the confounding effects of different pathogens. The excess mortality seen in patients with HCAP seems to have been related to differences in age and comorbidities (and to decisions to limit therapy), rather than to differences in antibiotic susceptibility.

— Thomas Glück, MD

Published in Journal Watch Infectious Diseases June 9, 2010

Citation(s):

Rello J et al. Why mortality is increased in health-care-associated pneumonia: Lessons from pneumococcal bacteremic pneumonia. Chest 2010 May; 137:1138.

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