Canan GÜNDÜZ, Oğuz KILINÇ, Ayşın ŞAKAR COŞKUN, Aykut ÇİLLİ, Mehmet Sezai TAŞBAKAN, Abdullah SAYINER

Clinical characteristics and outcome of healthcare associated pneumonia in Turkey

Giriş: Hastaneye yatış, hemodiyaliz programında bulunma, sağlık bakım evlerinde yaşama, önceki 30 günde evde yara bakımı öyküsü, ayaktan intravenöz tedavi ve kemoterapi öyküsü olan olgularda toplumda gelişen pnömoniler, sağlık bakımı ilişkili pnömoni (SBİP) olarak adlandırılmaktadır. Türkiye'de geniş bir popülasyonu kapsayan çalışmamızda, hastanede yatan toplumda gelişen pnömoni (TGP) ve SBİP olgularının başvuru özelliklerinin, laboratuvar verilerinin, etken dağılımlarının ve prognozlarının karşılaştırılması amaçlanmıştır.Materyal ve Metod: Türk Toraks Derneği Solunum Sistemi İnfeksiyonları Çalışma Grubu Pnömoni Veri Tabanı (TURCAP)'na yedi merkez tarafından kayıt edilmiş olan 785 (ortalama yaş 65.3 ± 16.4, 530 erkek) TGP ve SBİP olguları değerlendirilmiştir. Demografik özellikler, klinik öykü, pnömoni ağırlık skorları, laboratuvar ve radyolojik bulgular karşılaştırılmıştır.Bulgular: 785 olguda 207 (%26.4)'si SBİP ve 578 (%73.6)'i TGP tanısı almıştır. 207 SBİP olgusunun 140 (%67.6)'ının son 90 günde hastaneye yatış öyküsü olduğu, 28 (%3.6)'inin son 30 günde hemodiyaliz programına alındığı ve 22 (%10.6)'sinin sağlık bakım evinde kaldığı saptanmıştır. SBİP olgularında TGP'ye kıyasla komorbidite sıklığı artmış (%93.2'ye karşın %81.6; p= 0.001); PSI skoru yüksek (103.9 ± 37.2'ye karşın 94.6 ± 35.4; p= 0.002) saptanmıştır. Etken izolasyonu TGP'de %12.1 (70/578), SBİP'te %14.5 (30/207) oranında sağlanabilmiştir. Hastanede yatış süresi SBİP olgularında daha yüksek bulunmakla beraber (sırasıyla 8.6 ± 5.5'e karşın 7.5 ± 6.1 gün, p= 0.03); tedavi başarısı, yoğun bakımda kalış ve mortalite oranları açısından farklılık saptanmamıştır.Sonuç: TGP'ye kıyasla SBİP olgularında hastalık daha ağır seyretmekle beraber mortalitede fark izlenmemektedir. SBİP için mevcut kriterler olumsuz klinik sonuçları tahmin etmemektedir. Çok ilaca dirençli patojenlere yönelik lokal risk faktörleri tanımlayabilecek çalışmalara gereksinim vardır.

Türkiye'de sağlık bakımı ile ilişkili pnömoni olgularının klinik özellikleri ve sonuçları

Introduction: Pneumonia in cases with preceding hospitalization, hemodialysis, intravenous therapy, wound care, or chemotherapy within the prior 30 days and residence in nursing homes are defined as healthcare associated pneumonia (HCAP). The aim of this study was to compare the demographic and laboratory data, isolated causative agents and prognosis of patients with communityacquired pneumonia (CAP) and HCAP in a large population in Turkey. Materials and Methods: The data of 785 cases (average age 65.3 ± 16.4, 530 male) registered to Turkish Thoracic Society Respiratory Infections Study Group CAP database (TURCAP) were examined. The demographic data, clinical history, pneumonia severity scores (PSI), laboratory and radiologic findings of the CAP and HCAP patients were compared.Results: Out of 785 cases, 207 (26.4%) were diagnosed with HCAP and 578 (73.6%) with CAP. Among HCAP cases, 140/207 (67.6%) had preceding hospitalization in the last 90 days, 28/207 (13.5%) were on a hemodialysis program during the previous 30 days and 22/207 (10.6%) were staying in nursing homes. Patients with HCAP more frequently had comorbidities (93.2% vs. 81.6%; p= 0.001) and higher PSI scores (103.9 ± 37.2 vs. 94.6 ± 35.4; p= 0.002) compared to patients with CAP. A causative microorganism was isolated in only 12.1% (70/578) of CAP and 14.5% (30/207) of HCAP patients. The length of stay in hospital was higher in HCAP than CAP (8.6 ± 5.5 vs. 7.5 ± 6.1 days, p= 0.03); however the rates of treatment failure, intensive care unit admission and mortality were similar.Conclusion: In comparison to CAP, HCAP patients tend to have more severe disease, despite have no difference in mortality. The current criteria for HCAP do not predict worse clinical outcomes. Further work is required to define local risk factors for multidrugresistant pathogens.

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