醫療照護相關肺炎面面觀

Aspects of Healthcare-associated Pneumonia

醫療照護相關性肺炎（Healthcare-associated pneumonia, HCAP）於 2005 年由美國胸腔科學會/感染症協會的指引中引入，類似於醫院獲得性肺炎而非社區獲得性肺炎（Community-acquired pneumonia, CAP），常造成感染多重抗藥（Multidrug resistance, MDR）病原菌和不良的預後。近期研究顯示，與 CAP 相比 HCAP 發病時嚴重程度增加、死亡率更高。然而，不同觀察性研究中 MDR 病原體的發病率略有增加，但在大多數研究中還是偏低。這些研究說明傳統分類上的 HCAP 無法預測會得到抗藥性細菌，並不是對所有的 HCAP 的病人都需開立對抗多重抗藥性細菌的抗生素。考量台灣長期照護機構的普及和醫療資源頻繁使用情形，醫療照護相關肺炎應該被視為一個特別的臨床狀況，其概念仍需保留並適度了解，以免低估疾病嚴重度，而導致病人無法在第一時間獲得適當抗生素治療。 Healthcare-associated pneumonia (HCAP) was introduced in 2005 by the American Thoracic Society/Infectious Diseases Society of America guidelines as a new entity of pneumonia that resembles nosocomial pneumonia, rather than community-acquired pneumonia (CAP), in terms of frequency of multidrug-resistant (MDR) pathogens and outcomes. All studies demonstrated an increased severity of pneumonia at presentation and excess mortality from HCAP, compared to those with CAP. However, the incidence of MDR pathogens in different observational studies was slightly increased, but generally low in most studies. These studies suggest that the designation of HCAP is a poor predictor of resistant pathogens and that antibiotic coverage for MDR pathogens is not necessary in all patients with HCAP. HCAP should be regarded as a special clinical condition. Owing to widespread long-term care institutions in Taiwan and the frequent use of medical resources, the concept of HCAP still needs to be maintained and adequately understood. If we underestimate the severity of the disease, the patient would not be able to obtain appropriate antibiotic treatments immediately.

Healthcare-associated pneumonia (HCAP) was introduced in 2005 by the American Thoracic Society/Infectious Diseases Society of America guidelines as a new entity of pneumonia that resembles nosocomial pneumonia, rather than community-acquired pneumonia (CAP), in terms of frequency of multidrug-resistant (MDR) pathogens and outcomes. All studies demonstrated an increased severity of pneumonia at presentation and excess mortality from HCAP, compared to those with CAP. However, the incidence of MDR pathogens in different observational studies was slightly increased, but generally low in most studies. These studies suggest that the designation of HCAP is a poor predictor of resistant pathogens and that antibiotic coverage for MDR pathogens is not necessary in all patients with HCAP. HCAP should be regarded as a special clinical condition. Owing to widespread long-term care institutions in Taiwan and the frequent use of medical resources, the concept of HCAP still needs to be maintained and adequately understood. If we underestimate the severity of the disease, the patient would not be able to obtain appropriate antibiotic treatments immediately.