Impact of prior pulmonary tuberculosis in treatment outcomes of HCAP and CAP patients in intensive care units
Background/purpose: It is controversial whether healthcare-associated pneumonia (HCAP) belongs to a unique clinical entity or it shares common characteristics with community-acquired pneumonia (CAP). The impact of prior pulmonary tuberculosis (PTB) in clinical presentation and treatment outcome of I...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2019-04-01
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| Series: | Journal of Microbiology, Immunology and Infection |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S1684118218303463 |
| _version_ | 1811233583115796480 |
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| author | Fan-Min Lin Jia-Yih Feng Wen-Feng Fang Chieh-Liang Wu Chong-Jen Yu Meng-Chih Lin Shih-Chi Ku Chang-Wen Chen Chih-Yen Tu Kuang-Yao Yang |
| author_facet | Fan-Min Lin Jia-Yih Feng Wen-Feng Fang Chieh-Liang Wu Chong-Jen Yu Meng-Chih Lin Shih-Chi Ku Chang-Wen Chen Chih-Yen Tu Kuang-Yao Yang |
| author_sort | Fan-Min Lin |
| collection | DOAJ |
| description | Background/purpose: It is controversial whether healthcare-associated pneumonia (HCAP) belongs to a unique clinical entity or it shares common characteristics with community-acquired pneumonia (CAP). The impact of prior pulmonary tuberculosis (PTB) in clinical presentation and treatment outcome of ICU-admitted CAP and HCAP patients also remains unknown. Methods: We report a nationwide, multi-center, retrospective study. ICU-admitted CAP and HCAP patients from six medical centers in Taiwan were enrolled for analysis. Patients were defined as either CAP or HCAP cases, and with and without prior PTB, according to the database of Taiwan CDC. The disease severity, microbiologic characteristics, and treatment outcomes between CAP and HCAP patients with or without prior PTB were compared and analyzed. Results: A total of 414 ICU-admitted patients, including 176 CAP cases and 238 HCAP cases were included for analysis during the study period. In both CAP and HCAP subgroups, the pneumonia severities, proportions of organ dysfunction, and microbiologic characteristics were similar between patients with and without prior PTB. In survival analysis, patients with prior PTB had higher 30-day mortality than those without prior PTB (38.9% vs. 16.5%, p = 0.021) in the CAP population. Multivariate analysis revealed that a history of prior PTB was an independent clinical factor associated with higher 30-day mortality rate in CAP patients (HR = 4.45, 95% CI: 1.81–10.98, P = 0.001). Conclusion: History of prior PTB is an independent clinical factor for increased 30-day mortality rate in ICU-admitted CAP patients, but not in ICU-admitted HCAP patients. Keywords: Community-acquired pneumonia, Healthcare-associated pneumonia, Intensive care unit, Mortality, Tuberculosis |
| first_indexed | 2024-04-12T11:22:18Z |
| format | Article |
| id | doaj.art-88ccb6dc7855445792be3ca52a974c4e |
| institution | Directory Open Access Journal |
| issn | 1684-1182 |
| language | English |
| last_indexed | 2024-04-12T11:22:18Z |
| publishDate | 2019-04-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of Microbiology, Immunology and Infection |
| spelling | doaj.art-88ccb6dc7855445792be3ca52a974c4e2022-12-22T03:35:20ZengElsevierJournal of Microbiology, Immunology and Infection1684-11822019-04-01522320328Impact of prior pulmonary tuberculosis in treatment outcomes of HCAP and CAP patients in intensive care unitsFan-Min Lin0Jia-Yih Feng1Wen-Feng Fang2Chieh-Liang Wu3Chong-Jen Yu4Meng-Chih Lin5Shih-Chi Ku6Chang-Wen Chen7Chih-Yen Tu8Kuang-Yao Yang9Division of Pulmonary Medicine, Department of Internal Medicine, Kaohsiung Armed Forces General Hospital, Kaohsiung, TaiwanDepartment of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, TaiwanDivision of Pulmonary and Critical Care Medicine and Department of Respiratory Therapy, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi, TaiwanCenter for Quality Management, Taichung Veterans General Hospital, Taichung, TaiwanDepartment of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; College of Medicine, National Taiwan University, Taipei, TaiwanDivision of Pulmonary and Critical Care Medicine and Department of Respiratory Therapy, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi, TaiwanDepartment of Internal Medicine, National Taiwan University Hospital, Taipei, TaiwanMedical Intensive Care Unit, Department of Internal Medicine, National Cheng-Kung University Hospital, Tainan, TaiwanDivision of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan; School of medicine, China Medical University, Taichung, TaiwanDepartment of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Emergency and Critical Care Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan; Corresponding author. Department of Chest Medicine, Taipei Veterans General Hospital, No.201, Sec. 2, Beitou Rd., Beitou Dist., Taipei City 112, Taiwan. Fax: +886 2 28752380.Background/purpose: It is controversial whether healthcare-associated pneumonia (HCAP) belongs to a unique clinical entity or it shares common characteristics with community-acquired pneumonia (CAP). The impact of prior pulmonary tuberculosis (PTB) in clinical presentation and treatment outcome of ICU-admitted CAP and HCAP patients also remains unknown. Methods: We report a nationwide, multi-center, retrospective study. ICU-admitted CAP and HCAP patients from six medical centers in Taiwan were enrolled for analysis. Patients were defined as either CAP or HCAP cases, and with and without prior PTB, according to the database of Taiwan CDC. The disease severity, microbiologic characteristics, and treatment outcomes between CAP and HCAP patients with or without prior PTB were compared and analyzed. Results: A total of 414 ICU-admitted patients, including 176 CAP cases and 238 HCAP cases were included for analysis during the study period. In both CAP and HCAP subgroups, the pneumonia severities, proportions of organ dysfunction, and microbiologic characteristics were similar between patients with and without prior PTB. In survival analysis, patients with prior PTB had higher 30-day mortality than those without prior PTB (38.9% vs. 16.5%, p = 0.021) in the CAP population. Multivariate analysis revealed that a history of prior PTB was an independent clinical factor associated with higher 30-day mortality rate in CAP patients (HR = 4.45, 95% CI: 1.81–10.98, P = 0.001). Conclusion: History of prior PTB is an independent clinical factor for increased 30-day mortality rate in ICU-admitted CAP patients, but not in ICU-admitted HCAP patients. Keywords: Community-acquired pneumonia, Healthcare-associated pneumonia, Intensive care unit, Mortality, Tuberculosishttp://www.sciencedirect.com/science/article/pii/S1684118218303463 |
| spellingShingle | Fan-Min Lin Jia-Yih Feng Wen-Feng Fang Chieh-Liang Wu Chong-Jen Yu Meng-Chih Lin Shih-Chi Ku Chang-Wen Chen Chih-Yen Tu Kuang-Yao Yang Impact of prior pulmonary tuberculosis in treatment outcomes of HCAP and CAP patients in intensive care units Journal of Microbiology, Immunology and Infection |
| title | Impact of prior pulmonary tuberculosis in treatment outcomes of HCAP and CAP patients in intensive care units |
| title_full | Impact of prior pulmonary tuberculosis in treatment outcomes of HCAP and CAP patients in intensive care units |
| title_fullStr | Impact of prior pulmonary tuberculosis in treatment outcomes of HCAP and CAP patients in intensive care units |
| title_full_unstemmed | Impact of prior pulmonary tuberculosis in treatment outcomes of HCAP and CAP patients in intensive care units |
| title_short | Impact of prior pulmonary tuberculosis in treatment outcomes of HCAP and CAP patients in intensive care units |
| title_sort | impact of prior pulmonary tuberculosis in treatment outcomes of hcap and cap patients in intensive care units |
| url | http://www.sciencedirect.com/science/article/pii/S1684118218303463 |
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