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KMID : 0338420160310030525
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The Korean Journal of Internal Medicine
2016 Volume.31 No. 3 p.525 ~ p.534
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Intermediate risk of multidrug-resistant organisms in patients who admitted intensive care unit with healthcare-associated pneumonia
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Lee Hong-Yeul
Park Ji-Young
Lee Tae-Hoon
Lee Yeon-Joo
Lim Hyo-Jeong
Park Jong-Sun
Yoon Ho-Il
Lee Jae-Ho
Lee Choon-Taek
Cho Young-Jae
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Abstract
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Background/Aims: Healthcare-associated pneumonia (HCAP) was proposed asa new pneumonia category in 2005, and treatment recommendations includebroad-spectrum antibiotics directed at multidrug-resistant (MDR) pathogens.However, this concept continues to be controversial, and microbiological data arelacking for HCAP patients in the intensive care unit (ICU). This study was conductedto determine the rate and type of antibiotic-resistant organisms and theclinical outcomes in patients with HCAP in the ICU, compared to patients withcommunity-acquired pneumonia (CAP) or hospital-acquired pneumonia (HAP).
Methods: We conducted a retrospective cohort analysis of patients with pneumonia(n = 195) who admitted to medical ICU in tertiary teaching hospital fromMarch 2011 to February 2013. Clinical characteristics, microbiological distributions,treatment outcomes, and prognosis of HCAP (n = 74) were compared tothose of CAP (n = 75) and HAP (n = 46).
Results: MDR pathogens were significantly higher in HCAP patients (39.1%) thanin CAP (13.5%) and lower than in HAP (79.3%, p < 0.001). The initial use of inappropriateantibiotic treatment occurred more frequently in the HCAP (32.6%) andHAP (51.7%) groups than in the CAP group (11.8%, p = 0.006). There were no differencesin clinical outcomes. The significant prognostic factors were pneumoniaseverity and treatment response.
Conclusions: MDR pathogens were isolated in HCAP patients requiring ICU admissionat intermediate rates between those of CAP and HAP.
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KEYWORD
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Community-acquired pneumonia, Healthcare-associated pneumonia, Hospital-acquired pneumonia, Intensive care units, Multidrug-resistant pathogens
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