作者@article {Attridge878 = {Attridge,保留时间d Frei, C.R. and Restrepo, M.I. and Lawson, K.A. and Ryan, L. and Pugh, M.J.V. and Anzueto, A. and Mortensen, E.M.}, title = {Guideline-concordant therapy and outcomes in healthcare-associated pneumonia}, volume = {38}, number = {4}, pages = {878--887}, year = {2011}, doi = {10.1183/09031936.00141110}, publisher = {European Respiratory Society}, abstract = {Healthcare-associated pneumonia (HCAP) guidelines were first proposed in 2005 but have not yet been validated. The objective of this study was to compare 30-day mortality in HCAP patients treated with either guideline-concordant (GC)-HCAP therapy or GC community-acquired pneumonia (CAP) therapy. We performed a population-based cohort study of \>150 hospitals in the US Veterans Health Administration. Patients were included if they had one or more HCAP risk factors and received antibiotic therapy within 48 h of admission. Critically ill patients were excluded. Independent risk factors for 30-day mortality were determined in a generalised linear mixed-effect model, with admitting hospital as a random effect. Propensity scores for the probability of receiving GC-HCAP therapy were calculated and incorporated into a second logistic regression model. A total of 15,071 patients met study criteria and received GC-HCAP therapy (8.0\%), GC-CAP therapy (75.7\%) or non-GC therapy (16.3\%). The strongest predictors of 30-day mortality were recent hospital admission (OR 2.49, 95\% CI 2.12{\textendash}2.94) and GC-HCAP therapy (OR 2.18, 95\% CI 1.86{\textendash}2.55). GC-HCAP therapy remained an independent risk factor for 30-day mortality (OR 2.12, 95\% CI 1.82{\textendash}2.48) in the propensity score analysis. In nonsevere HCAP patients, GC-HCAP therapy is not associated with improved survival compared with GC-CAP therapy.}, issn = {0903-1936}, URL = {//www.qdcxjkg.com/content/38/4/878}, eprint = {//www.qdcxjkg.com/content/38/4/878.full.pdf}, journal = {European Respiratory Journal} }