医療ケア関連肺炎に関する前向き疫学調査  [in Japanese] Prospective Observational Study of Healthcare Associated Pneumonia  [in Japanese]

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Abstract

医療ケア関連肺炎(HCAP)は,ATS/IDSAの肺炎のガイドライン(2005年)にて提唱された概念である.当院におけるHCAPの特徴を明らかにする目的で前向き研究を行った.2010年1~12月に獨協医科大学越谷病院呼吸器内科に市中肺炎で入院した患者を対象とした.HCAPと市中肺炎(CAP)の判断にあたっては, HCAP疑い因子の有無をアンケートにより調査した.それ以外の介入は行わず,背景因子,肺炎重症度,肺炎の再燃の有無について調査した.年齢はHCAP 73±10歳,CAP 65±9歳(p<0.05)と両群間で有意差を認め,HCAP群では悪性腫瘍の合併が多く(p<0.05),自立度が低かった(p<0.05).入院時検査所見,胸部X線点数は,両群間に有意差を認めなかった.肺炎重症度は,A-DROPでは,HCAP群が,軽症30%,中等症63%,重症7%,CAP群が,軽症75%,中等症12%,重症13%で,有意差がみられた(p<0.05)が,PSIスコアでは,重症度に有意差を認めなかった.30日以内の肺炎再燃はHCAP群で21%,CAP群では0%であった.本研究より,HCAPでは,入院時の重症度に関らず,より慎重な経過観察が必要であることが示唆された.詳細にHCAP危険因子に関する病歴を聴取し,HCAPをCAPと誤認しないようにすることが重要である.

Backgrounds:Healthcare associated pneumonia(HCAP) is a new concept proposed in guidelines for themanagement of adults with hospital-acquired, ventilatorassociated,and healthcare-associated pneumonia by ATS/IDSA. Several retrospective studies investigating the characteristicof HCAP in Japan have been performed. However,at present, a cohort study exploring the characteristic ofHCAP in Japan has not been published.Patients and Methods:This study was a prospectiveobservational study. Patients with pneumonia who admittedto Dokkyo Medical University Koshigaya Hospital betweenJanuary and December in 2010 were enrolled in this study.After giving informed consent, the patients were requestedto fill out a questionnaire designed to obtain informationabout risk factors of HCAP and divided into groups, HCAPor CAP, and their clinical characteristics were observed.Results:Mean age of enrolled patients were 73±10 yr inHCAP and 65±9 yr in CAP (p<0.05). The percentage ofpatients with malignant diseases were higher in HCAPgroup (p<0.05). There were no statistically significant differencesin WBC, CRP or chest X ray score on admissionbetween the groups. A-DROP score showed statistically asignificant difference between the groups while PSI scoredid not. The recurrence of pneumonia within 30 days afterdischarge of hospital was 21 % in HCAP groups but 0 % inCAP group.Conclusion:This study showed that patients withHCAP need to receive more careful care and observation toprevent recurrence even though the severity of pneumoniaon admission was not very high. It is crucial to take patients'history carefully to identify correctly whether a patientis with HCAP or CAP.

Journal

  • Dokkyo journal of medical sciences

    Dokkyo journal of medical sciences 40(2), 79-85, 2013-07-25

Codes

  • NII Article ID (NAID)
    110009606243
  • NII NACSIS-CAT ID (NCID)
    AA00629581
  • Text Lang
    JPN
  • Article Type
    journal article
  • ISSN
    0385-5023
  • Data Source
    NII-ELS  IR 
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