Clinical Characteristics of Nursing and Healthcare-Associated Pneumonia: A Japanese Variant of Healthcare-Associated Pneumonia

Ishida, Tadashi; Takahashi, Hiromasa; Ito, Akihiro; Yoshioka, Hiroshige; Arita, Machiko; Hashimoto, Toru

doi:10.2169/internalmedicine.51.7987

Cited by 75 publications

(59 citation statements)

References 18 publications

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“…It is thought that NHCAP is a variant of HCAP, proposed by the ATS and the IDSA in 2005, on the basis of the Japanese system of healthcare and social health insurance 2) . According to previous reports, patients with HCAP have tendency toward having poor prognoses because they were more likely to have drug-resistant pathogens and to have been initially administered inappropriate antimicrobial than the patients with pneumonia who do not meet the criteria for HCAP 3) 5) 6) .…”

Section: Discussionmentioning

confidence: 99%

“…It is thought that NHCAP is a variant of healthcare-associated pneumonia (HCAP), proposed by the American Thoracic Society (ATS) and the Infectious Disease Society of America (IDSA) in 2005 1) , based on the Japanese healthcare and social health-insurance system 2) . NHCAP generally develops in patients with various complications or in bedridden elderly patients 2) . It has both the clinical characteristics of community-acquired pneumonia (CAP) and those of hospital-acquired pneumonia (HAP) 2) .…”

Section: Introductionmentioning

confidence: 99%

“…NHCAP generally develops in patients with various complications or in bedridden elderly patients 2) . It has both the clinical characteristics of community-acquired pneumonia (CAP) and those of hospital-acquired pneumonia (HAP) 2) . Predicting the prognosis of 354 Original Articles Juntendo Medical Journal 2017.…”

Section: Introductionmentioning

confidence: 99%

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A Retrospective Analysis of Prognostic Factors of Nursing and Healthcare-Associated Pneumonia

Hara

Iwakami

Sasaki

et al. 2017

Juntendo Medical Journal

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Objective: Nursing and healthcare-associated pneumonia (NHCAP) is similar to healthcare-associated pneumonia (HCAP) -a category of pneumonia proposed by the Japanese Respiratory Society (JRS). This study aims to determine the thus far unclear prognostic factors of NHCAP patients, and to clarify the relevance and effectiveness of the selection of antimicrobial agents in accordance with the NHCAP guidelines proposed by the JRS. Materials:A retrospective observational study of NHCAP patients hospitalized at Juntendo University Shizuoka Hospital between January, 2010 and December, 2012 was undertaken.Methods: Clinical data were obtained from clinical records, and subjects were assigned to a group which included survived patients at 30 days after admission, and a group which included patients who died within 30 days. The groups were compared regarding baseline characteristics, vital signs, laboratory data, performance status, determination of the severity of the pneumonia (such as with the A-DROP scoring system proposed by the JRS in cases of community-acquired pneumonia), microbiological examinations, and the antimicrobial agents used initially.Results: 151 NHCAP patients in total were evaluated. A score of 3 or more in the A-DROP scoring system is a factor that has an independent influence on NHCAP patientsʼ prognoses. There were no statistically significant differences in the use of broad-spectrum antimicrobials between the two groups, even those where the use of broad-spectrum antimicrobials was recommended. Conclusion:The results suggest that the severity of the pneumonia is an independent prognostic factor of NHCAP patients, for whom using broad-spectrum antimicrobials does not contribute to improving their prognoses.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A Retrospective Analysis of Prognostic Factors of Nursing and Healthcare-Associated Pneumonia

Hara

Iwakami

Sasaki

et al. 2017

Juntendo Medical Journal

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“…Ishida et al reported 451 NHCAP patients with a mean age of 82 years; the mortality rate during hospitalization was 13.1%; and the percentage of patients given penicillin antimicrobial agents containing a β-lactam inhibitor was 74% in a community hospital in Japan [19]. Oshitani et al reported 477 NHCAP patients with a mean age of 84 years; the mortality rate during hospitalization was 24.7%; and the percentage of patients initially treated with ABPC/SBT was 64.6% [20].…”

Section: Discussionmentioning

confidence: 99%

Effects of Ampicillin/Sulbactam Dose and Dosing Frequency in Elderly Patients with Nursing- and Healthcare-Associated Pneumonia (Nhcap)

Yamazaki¹,

Sugawara²

2016

J Infect Dis Ther

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Japan has the most rapidly aging population in the world. This study aimed to examine the differences in the efficacy of ampicillin/sulbactam (ABPC/SBT) alone under different daily doses and daily dosing frequencies in elderly patients receiving healthcare at home and in elderly nursing home residents with pneumonia onset requiring hospitalization for treatment. By applying the Clinical Practice Guidelines for Nursing-and Healthcare-associated Pneumonia (NHCAP) of the Japanese Respiratory Society (JRS), we retrospectively analyzed clinical data, dose, dosing period, and the efficacy of antimicrobial agents, as well as outcomes of patients with NHCAP or community acquired pneumonia (CAP) who had been hospitalized at our department during the 3-year period of 2009 through 2011. The mean age of NHCAP patients (n=587) was 85 ± 9 years, significantly higher than the 77 ± 16 years of CAP patients (n=319). The serum albumin level in NHCAP patients was significantly lower than that in CAP patients. Among NHCAP patients, 82.5% received ABPC/SBT alone as the first-line therapy, with 50.7% receiving 1.5 g three times daily and 22.8% receiving 3 g twice daily. The mortality rate during hospitalization in the 1.5-g three-times-daily group was 12.4%, resulting in a significantly decrease as compared with the 3-g twice-daily group of 20.9% (p<0.01). In our study, which targeted the elderly in Japan, it was revealed that ABPC/SBT is an appropriate first choice of antibiotics in treating NHCAP and that administering 1.5 g three times daily is a suitable way of administration.

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“…In 2011, the Japanese Respiratory Society proposed a modi ed concept of HCAP called nursing and healthcare-associated pneumonia , considering the epidemiological and social environmental situations in Japan 37 . Ishida et al 38 revealed the usefulness of the guidelines in a prospective manner. To de ne better strategies and to mitigate negative outcomes from HCAP, further studies are needed to identify predictive factors of MDR pathogens and prognostic factors.…”

Section: Discussionmentioning

confidence: 99%

Etiology and Factors Contributing to Mortality in Healthcare-associated Pneumonia: A Single-center Study

Ishiguro¹,

Takayanagi²,

Gochi³

et al. 2013

Showa Univ J Med Sci

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: Factors contributing to mortality in healthcare-associated pneumonia HCAP have not been investigated fully. We reviewed the etiology and identi ed prognostic factors of HCAP in hospitalized patients. We conducted a retrospective study of 500 Japanese patients with HCAP to assess these factors, with special emphasis on microbial etiology. Patients with HCAP were older 73.4 11.4 years , more predominantly male 74.4 , and had more smoking history and comorbidity than did community-acquired pneumonia CAP patients. Microbes were identi ed in 52.8 of HCAP patients. The most frequent causative microbial agents were Streptococcus pneumoniae n 108, 21.6 , influenza virus n 47, 9.4 , and Pseudomonas aeruginosa n 40, 8.0 . Multiple drug-resistant MDR pathogens were more frequent in HCAP patients 9.8 than CAP patients. Overall, 47 HCAP patients 9.4 died, with mortality being higher in HCAP than CAP patients. The three leading causes of non-survival from HCAP were S. pneumoniae, in uenza virus, and P. aeruginosa. MDR pathogens accounted for 21.3 of non-survivors. Multivariate analysis revealed disease severity on admission and treatment failure of initial antibiotics as independent factors for 30-day mortality. Among patients with treatment failure of initial antibiotics, 29.9 had received appropriate antibiotics. The most frequent pathogens in HCAP were S. pneumoniae, in uenza virus, and P. aeruginosa, in both survivors and nonsurvivors. Disease severity on admission and treatment failure of initial antibiotics were independent factors for mortality. MDR pathogens are important therapeutic targets to mitigate negative results, and treatment strategies other than antibiotic selection are also required.

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Clinical Characteristics of Nursing and Healthcare-Associated Pneumonia: A Japanese Variant of Healthcare-Associated Pneumonia

Cited by 75 publications

References 18 publications

A Retrospective Analysis of Prognostic Factors of Nursing and Healthcare-Associated Pneumonia

A Retrospective Analysis of Prognostic Factors of Nursing and Healthcare-Associated Pneumonia

Effects of Ampicillin/Sulbactam Dose and Dosing Frequency in Elderly Patients with Nursing- and Healthcare-Associated Pneumonia (Nhcap)

Etiology and Factors Contributing to Mortality in Healthcare-associated Pneumonia: A Single-center Study

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