健康照護相關肺炎

Health Care Associated Pneumonia

徐國軒(Kuo-Hsuan Hsu) ； 吳杰亮(Chieh-Liang Wu)

《重症醫學雜誌》 11卷1期 (2010/03) Pp. 18-24

https://doi.org/10.30035/TCCM.201003.0003

摘要

肺炎已是國人十大死亡原因的第四位，其中以老年人爲主。肺炎的臨床診斷，通常依流行病學的資料，考量抗藥菌種的風險與經驗性抗生素使用的原則，把肺炎分成社區肺炎和院內肺炎。如果病患有使用呼吸器則歸爲呼吸器相關肺炎。文獻資料發現先前住過院者、住在安養院或長期照護機構者、曾接受針劑抗生素、化學治療、傷口照護的病患，洗腎的病人等，有可能得到多重抗藥性菌株感染的肺炎，但是這些病患過去通常被歸爲社區肺炎。2005年美國胸腔醫學會與感染症醫學會根據菌株感染的不同，對此提出健康照護相關肺炎的新概念。目前有關健康照護相關肺炎的研究結論相當分歧，健康照護相關肺炎菌種分佈也不一致，可能和收案條件與研究的方法不相同或病患嚴重度差異大有關。然而健康照護相關肺炎和社區肺炎比較時，不管在嚴重度、合併症的比率、住院天數、死亡率、和菌種分佈都不同，證實社區肺炎和健康照護相關肺炎是不同的疾病。但從這些資料也顯示健康照護相關肺炎病人的多樣性，加上台灣老年人口增加，長期照護機構的設置，醫療的方便性，台灣的健康照護相關肺炎應有其特殊性，必需進一步研究以利臨床肺炎診治。

關鍵字

肺炎 ； 健康照護相關肺炎 ； 社區肺炎 ； 長期照護服務 ； 安養院

並列摘要

Pneumonia has been the 4(superscript th) leading cause of death in Taiwan. Most of the patients with pneumonia are aged. Based on the historical data and the risk for drug-resistant organisms, pneumonia is categorized into community acquired pneumonia (CAP) and hospital acquired pneumonia (HAP) and ventilator associated pneumonia (VAP). Recently, health care associated pneumonia (HCAP) is designed as the 4th category of pneumonia for those patients with previous hospitalization, regular hemodialysis, residence in a nursing home or extended care facility, etc. HCAP usually mimics CAP in those patients from community but with high risk for multiple drug resistant organisms. We examined three retrospective and one prospective studies of HCAP. It is evidenced that HCAP is different from CAP based on the difference of disease severity, outcome, length of hospital stay and infective organisms. However, the patients of HCAP are also heterogeneous. The demographic data and core pathogens of HCAP are also varied among these studies. In Taiwan, aged patients resides in long-term care facility accessed medical care easily, we should determine the characteristics of HCAP for the management of pneumonia in Taiwan.

並列關鍵字

Pneumonia ； Community acquired pneumonia ； Health care associated pneumonia ； Long term care facility ； Nursing home