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Health-Care-Associated Pneumonia Among Hospitalized Patients in a Japanese Community Hospital.
Chest. 2008 Nov 18;
Authors: Shindo Y, Sato S, Maruyama E, Ohashi T, Ogawa M, Hashimoto N, Imaizumi K, Sato T, Hasegawa Y
Background Healthcare-associated pneumonia (HCAP) is a relatively new concept. Epidemiologic studies are limited and initial empirical antibiotic treatment is still under discussion. This study aimed to reveal the differences in mortality and pathogens between HCAP and community-acquired pneumonia (CAP) in each severity class and to clarify the strategy for the treatment of HCAP. Methods We conducted a retrospective observational study of patients with HCAP and CAP who were hospitalized between November 2005 and January 2007, and compared baseline characteristics, severity, pathogen distribution, antibiotic regimens, and outcomes. In each severity class (mild, moderate, and severe) assessed using the A-DROP scoring system, we investigated the in-hospital mortality and occurrence of potential drug-resistant (PDR) pathogens. Results A total of 371 patients (141 HCAP, 230 CAP) were evaluated. The proportion of patients in the severe class was higher in HCAP than in CAP patients. In the moderate class, the in-hospital mortality of HCAP patients was significantly higher than that of CAP patients (11.1% vs 1.9%; p = 0.008). In moderate-class patients in whom pathogens were identified, PDR pathogens were isolated more frequently from HCAP than from CAP patients (22.2% vs 1.9%; p = 0.002). The occurrence of PDR pathogens was associated with initial treatment failure and inappropriate initial antibiotic treatment. Conclusions The present study provides additional evidence that HCAP should be distinguished from CAP, and suggests that the therapeutic strategy for HCAP in the moderate class holds the key to improving mortality. Physicians may need to consider PDR pathogens in selecting the initial empirical antibiotic treatment of HCAP.
PMID: 19017892 [PubMed - as supplied by publisher]