Burden of Adult Community-acquired, Health-care-Associated, Hospital-Acquired, and Ventilator-Associated Pneumonia: New York City, 2010 to 2014

Rachel E. Corrado, David Lee, David E. Lucero, et al

Chest 2017; 152: 930-942

DOI: http://dx.doi.org/10.1016/j.chest.2017.04.162

Background 背景

Although pneumonia is a leading cause of death in New York City (NYC), limited data exist about the settings in which pneumonia is acquired across NYC. Cases of pneumonia acquired in community settings are more likely to be preventable with vaccines and treatable with first-line antibiotics than those acquired in noncommunity settings. The objective of this study was to estimate the burden of hospitalizations associated with community-acquired (CAP), health-care-associated (HCAP), hospital-acquired (HAP), and ventilator-associated (VAP) pneumonia from 2010 to 2014.

尽管肺炎是纽约市的首要死因，但有关NYC不同场景下肺炎发生率的资料极为有限。与非社区获得性肺炎相比，社区获得性肺炎更容易通过疫苗接种预防，或采用一线抗生素治愈。本研究的目的在于估计2010至2014年间因社区获得性肺炎(CAP)、医疗机构相关性肺炎(HCAP)、医院获得性肺炎(HAP)及呼吸机相关性肺炎(VAP)住院的疾病负担。

Methods 方法

This retrospective analysis was performed by using an all-payer reporting system of hospital discharges that included NYC residents aged ≥ 18 years. Pneumonia-associated hospitalizations were defined as any hospitalization that included a diagnostic code for pneumonia among any of the discharge diagnoses. Using published clinical guidelines, we classified hospitalizations into mutually exclusive categories of CAP, HCAP, HAP, and VAP and defined pneumonia acquired in the community setting as the combination of CAP and HCAP.

采用18岁以上的NYC居民出院病例全付费人报告系统进行回顾性分析。肺炎相关住院定义为出院诊断中包含肺炎的任何住院。采用发表的临床指南，我们把住院病人分为相互独立的CAP, HCAP, HAP, 和 VAP，并将社区获得的肺炎定义为CAP和HCAP。

Results 结果

Of 4,614,108 hospitalizations during the reporting period, 283,927 (6.2%) involved pneumonia. Among pneumonia-associated hospitalizations, 154,158 (54.3%) were CAP, 85,656 (30.2%) were HCAP, 39,712 (14.0%) were HAP, and 4,401 (1.6%) were VAP. Death during hospitalization occurred in 7.9% of CAP-associated hospitalizations, compared with 15.6% of HCAP-associated hospitalizations, 20.7% of HAP-associated hospitalizations, and 21.6% of VAP-associated hospitalizations.

在报告期间总共4,614,108次住院中， 283,927 (6.2%) 涉及肺炎。在肺炎相关住院患者中，154,158例 (54.3%) 为CAP，85,656例 (30.2%)为HCAP，39,712例 (14.0%)为HAP，4,401 (1.6%)为VAP。CAP患者住院期间病死率7.9%，HCAP患者为15.6%，HAP为20.7%，VAP为21.6%。

Conclusions 结论

Most pneumonia-associated hospitalizations in NYC involve pneumonias acquired in the community setting. Although 15.6% of pneumonia-associated hospitalizations were categorized as HAP or VAP, these pneumonias accounted for > 25% of deaths from pneumonia-associated hospitalizations. Public health pneumonia prevention efforts need to target both community and hospital settings.

NYC多数肺炎相关住院患者为社区获得的肺炎。尽管15.6%的肺炎相关住院患者为HAP或VAP，但这些肺炎导致25%以上的死亡。肺炎的公共卫生策略需要针对这些社区和医院获得性肺炎。

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