국내 대학 병원에 입원한 혈액 투석 관련 폐렴 환자들의 임상적 특성 : 지역사회 획득성 폐렴과의 비교

Abstract

Background: In the 2005 ATS/IDSA guidelines, hemodialysis-associated pneumonia (HDAP) was included as a category of healthcare-associated pneumonia (HCAP). But the clinical epidemiology of HDAP has been not well established. This study aimed to evaluate the clinical and microbiological characteristics of the HDAP patients compared to community-acquired pneumonia (CAP). Methods: We conducted a retrospective observational study on HDAP patients who were admitted between January 2012 and August 2014. We compared clinical features, distribution of microorganisms, antibiotic regimens, and clinical outcome among three groups. Results: A total of 673 patients were evaluated during the study period, comprising 415 patients with CAP and 24 with HDAP. The median PSI score of the HDAP group was higher than that of the CAP group. The major pathogen was Staphylococcus aureus in the HDAP, whereas Streptococcus pneumoniae was the most frequently isolated pathogens in the CAP groups. The isolated rate of multidrug-resistant pathogens did not differ from between two groups. In the HDAP group, although the rate of administration of empirical multidrug-resistant pathogens targeted antibiotic regimens was more frequent rather than the CAP group, the rate of changing of antibiotics was significantly higher due to de-escalation of antibiotics. And the other clinical outcomes including total in-hospital mortality rate were similar to the both groups. Conclusions: Based on microorganisms and clinical outcomes, the HDAP group was clinically similar to the CAP group. Therefore, the 2005 ATS/IDSA guidelineincluded HDAP as a category of HCAP may have to be reassessed through further large-scale, prospective studies.