Health-Care-Associated Pneumonia Among Hospitalized Patients in a Japanese Community Hospital

Shindo, Yuichiro; Sato, Shinji; Maruyama, Eiichi; Ohashi, Taiki; Ogawa, Masahiro; Hashimoto, Naozumi; Imaizumi, Kazuyoshi; Sato, Tosiya; Hasegawa, Yoshinori

doi:10.1378/chest.08-1357

Cited by 239 publications

(284 citation statements)

References 26 publications

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“…We found that patients with HCAP were older than those with CAP, results that support two studies from Japan [12,16]. Complications were also more frequently found in patients with HCAP.…”

Section: Discussionsupporting

confidence: 88%

“…Shindo et al reported that 39% of patients with HCAP had been hospitalized for at least 2 days in the preceding 90 days and 61.0% resided in a nursing home or extended care facility [12]. Maruyama et al reported that in a rural region of Japan where the population over 65 years of age represents 30% of the population, 69.4% were patients with HCAP (NHAP) and 30.6% were patients with HAP [16].…”

Section: Discussionmentioning

confidence: 99%

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Characteristics and disease severity of healthcare-associated pneumonia among patients in a hospital in Kitakyushu, Japan

Seki

Hashiguchi

Tanaka

et al. 2011

Journal of Infection and Chemotherapy

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Pseudomonas spp. and anaerobes were isolated from patients with HCAP than from those with CAP. Conversely, more Streptococcus pneumoniae was detected and more penicillin was used in patients with CAP. This study provides additional evidence that HCAP should be distinguished from CAP and suggests the pathogenesis and therapeutic strategy for HCAP may be similar to those of hospital-acquired pneumonia (HAP). Seki et al., Page 3 3

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“…We found that patients with HCAP were older than those with CAP, results that support two studies from Japan [12,16]. Complications were also more frequently found in patients with HCAP.…”

Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Characteristics and disease severity of healthcare-associated pneumonia among patients in a hospital in Kitakyushu, Japan

Seki

Hashiguchi

Tanaka

et al. 2011

Journal of Infection and Chemotherapy

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“…In one study of CAP subjects Ͼ 65 y old, the functional status for activities of daily living was the best mortality predictor 24 ; other studies reached similar conclusions. 17,18,20 Another reason for the higher mortality is the higher incidence of MDR bacteria and thus the administration of inappropriate empirical antibiotic treatment.…”

Section: Discussionmentioning

confidence: 76%

A Worldwide Perspective of Nursing Home-Acquired Pneumonia Compared With Community-Acquired Pneumonia

et al. 2013

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the Community-Acquired Pneumonia Organization (CAPO) Investigators BACKGROUND: Nursing home-acquired pneumonia (NHAP) is the leading cause of death among long-term care patients and the second most common cause of transfers to acute care facilities. The aim of this study was to characterize the incidence, microbiology, and outcomes for hospitalized patients with community-acquired pneumonia (CAP) and NHAP. METHODS: A secondary analysis of 5,160 patients from the Community-Acquired Pneumonia Organization database was performed. World regions were defined as the United States and Canada (I), Latin America (II), and Europe (III). RESULTS: From a total of 5,160 hospitalized patients with CAP, NHAP was identified in 287 (5.6%) patients. Mean age was 80 y. NHAP distribution by region was 6% in region I, 3% in region II, and 7% in region III. Subjects with NHAP had higher frequencies of neurological disease, diabetes mellitus, congestive heart failure, and renal failure than did subjects with CAP (P < .001). ICU admission was required in 32 (12%) subjects. Etiology was defined in 68 (23%) subjects with NHAP and 1,300 (27%) with CAP. The most common pathogens identified in NHAP included Streptococcus pneumoniae (31%), Staphylococcus species (31%), and Pseudomonas aeruginosa (7%). Presentation of NHAP more frequently included pleural effusions (34% vs 21%, P < .001) and multilobar involvement (31% vs 24%, P < .001). Thirty-day hospital mortality was statistically greater among subjects with NHAP than among those with CAP (42% vs 18%, P < .001). CONCLUSIONS: Worldwide, only a very small proportion of hospitalized patients with CAP present with NHAP; the poor outcomes for these patients may be due primarily to a higher number of comorbidities compared with patients without NHAP.

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“…They concluded that HCAP is a heterogeneous disease and not all HCAP patients require a broad-spectrum multidrug regimen. Actually, several reports [10,13,[18][19][20] from Japan showed various values of frequency of MDR-pathogens and mortality rate of HCAP patients: frequency of MDR-pathogens was 3.3% to 42.9%; and mortality rate was 1.8% to 21.3%. In addition, the recent Japanese study [20] reported that the characteristics of HCAP patients are different between those admitted to large hospitals or small hospitals.…”

Section: Discussionmentioning

confidence: 99%

“…Patients are diagnosed with NHCAP when they met at least one of the following criteria: (1) having been admitted to the long-term care hospital or nursing home; (2) discharge from hospital in the preceding 90 days; (3) elder or physically disability people who need care (ECOG PS score ≥3); (4) outpatients who receive infusion therapy (including dialysis, antibiotics, anticancer agent, and immunosuppressant drug). Complications were defined as described previously [9][10][11][12][13].…”

Section: Definitionsmentioning

confidence: 99%

The definition of healthcare-associated pneumonia (HCAP) is insufficient for the medical environment in Japan: a comparison of HCAP and nursing and healthcare-associated pneumonia (NHCAP)

Kaku

Yanagihara

Morinaga

et al. 2013

Journal of Infection and Chemotherapy

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Healthcare-associated pneumonia (HCAP) is a new concept of pneumonia, which was proposed in ATS/IDSA guidelines. The guidelines explain that HCAP patients should be treated with broad-spectrum antimicrobial drugs directed at multidrug-resistant (MDR)-pathogens. However, in Japan, there are many elderly people who received an in-home care service. They seemed to be consistent with the concept of HCAP, but they didn't meet the definition of HCAP. Therefore, the Japanese Respiratory Society modified the definition of HCAP according to medical environmental in Japan. We retrospectively observed HCAP patients and nursing and healthcare-associated pneumonia (NHCAP) patients who were hospitalized between 24 months at the Japanese Red Cross Nagasaki Genbaku Hospital (Nagasaki, Japan). Patient background, disease severity, identified pathogens, initial antibiotic regimens, and outcomes were compared. A total of 108 patients (77 HCAP and 31 NHCAP except HCAP patients) were evaluated. Of NHCAP except HCAP patients, 27 (87.1%) were over 3 in ECOG PS score. There were almost no significantly differences between two groups in the characteristics, pneumonia severity, identified bacteria, initial antibiotic regimens, and response rate of initial antibiotic therapy. Although the in-hospital mortality of HCAP patients and NHCAP except HCAP patients was 9.1% and 19.4%, respectively, this difference did not reach Kaku et al., Page 3 statistical significance (P>0.05). Our study suggested that, in the criteria of HCAP, some Japanese patients, who were consistent with the concept of HCAP, were classified into community-acquired pneumonia. Therefore, there is a need to change the definition of HCAP according to medical environment in Japan.

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Health-Care-Associated Pneumonia Among Hospitalized Patients in a Japanese Community Hospital

Cited by 239 publications

References 26 publications

Characteristics and disease severity of healthcare-associated pneumonia among patients in a hospital in Kitakyushu, Japan

Characteristics and disease severity of healthcare-associated pneumonia among patients in a hospital in Kitakyushu, Japan

A Worldwide Perspective of Nursing Home-Acquired Pneumonia Compared With Community-Acquired Pneumonia

The definition of healthcare-associated pneumonia (HCAP) is insufficient for the medical environment in Japan: a comparison of HCAP and nursing and healthcare-associated pneumonia (NHCAP)

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