Download A Comparison of Culture-Positive and Culture-Negative Health

A Comparison of Culture-Positive and
Culture-Negative Health-Care-Associated
Pneumonia
Andrew J. Labelle, Heather Arnold, Richard M.
Reichley, Scott T. Micek and Marin H. Kollef
Chest 2010;137;1130-1137;
R2 Ja Won Koo/Prof. Heung Mo Kang
BackGround
Community-acquired
pneumonia
Hospital-acquired
pneumonia
Health-care-associated pneumonia (HCAP)
Infected with potentially antibiotic resistant bacteria
→ broader initial empirical antimicrobial therapy
Prior studies have suggested that there may be differences between
Culture-Positive (CP) patients and Culture-Negative (CN) patients
Objective
1. Determine whether important demographic differences,
including risk factors for HCAP, exist between CP and CN patients.
2. Compare the outcomes of these two groups to better understand
the implications of initial antimicrobial therapy
Methods
•
Patients
1.
2.
3.
diagnosis of HCAP between January 2003 and December 2005
Risk Factor
(1) residence in a nursing home, rehabilitation hospital, or other longterm in a nursing facility
(2) previous hospitalization within the immediately preceding 12 months
(3) receiving outpatient hemodialysis, peritoneal dialysis, wound care, or
infusion therapy necessitating regular visits to a hospital-based
clinic
(4) having an immune-compromised state.
New radiographic infiltrate
At least two of the following :
leukocytosis (10x109 cells/L), leukopenia (4x109 cells/L),
fever(38.3°C), hypothermia (36.0°C),
purulent secretions from the lower respiratory tract, or PaO2 /Fio2<300.
• A positive culture - growth of a pathogenic organism from
sputum, tracheal aspirate, bronchoscopic or blind BAL fluid, or
blood. a positive urinary antigen test for Legionella qualified as a
positive culture.
• Initial antibiotic therapy was defined as appropriate if it complied
with the recommendations of the ATS/IDSA guidelines for HCAP
• Escalation of therapy - the switch to or addition of an
antimicrobial agent with a broader spectrum of action
• De-escalation of therapy - switch to or discontinuation of a drug
class resulting in a less broad spectrum of coverage
Result
N=870
Figure 1
Figure 2
Conclusion
• Patients with CN HCAP had lower severity of illness, hospital
mortality, and hospital length of stay compared with CP
patients.
• Further studies are required to confirm these findings and to
determine the optimal empirical antimicrobial treatment
approaches for patients with HCAP.