[Results of survey of adult community-acquired pneumonia utilizing flow chart of diagnostic guideline for management of respiratory infections].
We performed a nationwide survey of 1,258 patients to assess the treatment of community-acquired pneumonia in Japan. Cases were classified as bacterial pneumonia in which the causal organism was unknown (Type A) or presumed (Type B), atypical pneumonia (Type C), severe pneumonia (Type D), or pneumonia in certain specific morbid states (Type E). Our objectives were to assess the actual use of antimicrobials and to determine the usefulness of the "Guidelines on Respiratory Infections--Basic Concepts in the Medical Care of Community-Acquired Pneumonia in Adults", developed by the Guideline-Drafting Committee of the Japanese Respiratory Society (JRS), in differentiating these categories of patients. We also hoped to elicit constructive opinions that would contribute to future revisions of these guidelines. The findings showed that pneumonia was classified as "bacterial pneumonia in which the causal organism was unknown" in approximately half (50.2%) of the patients studied. The next most common classification was "severe pneumonia", followed by "atypical pneumonia", "bacterial pneumonia in which the causal organism was presumed", and "pneumonia in certain specific morbid states", in that order. Our results suggest that the JSR guidelines, including the methods for differentiating between bacterial pneumonia and atypical pneumonia, are useful and appropriate, and that antimicrobial agents were generally selected in accordance with the guidelines. We also identified a number of issues to be addressed in future updates of the guidelines, including criteria for physiological assessment, handling of cases in which physical findings and laboratory test results are not in agreement, age-related issues (especially the treatment of patients 65 years of age and older), the differentiation between bacterial pneumonia and atypical pneumonia, the weighing of underlying diseases and complications, and guidelines regarding the use of adjuvant therapy.
Watanabe
Akira
A
Department of Respiratory Medicine, Institute of Development, Aging and Cancer, Tohoku University.
Matsushima
Toshiharu
T
Kohno
Shigeru
S
Abe
Shosaku
S
Aoki
Nobuki
N
Kubo
Keishi
K
Sugiyama
Yukihiko
Y
Kikuchi
Norio
N
Kudou
Shoji
S
Ishigatsubo
Yoshiaki
Y
Shimokata
Kaoru
K
Hirata
Kazuto
K
Tohda
Yuji
Y
Narita
Nobuhiro
N
Ueda
Nobuo
N
Niki
Yoshihito
Y
Nasu
Masaru
M
Saitou
Atsushi
A
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D017714:Community-Acquired Infections / Q000145:classification / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D003937:Diagnosis, Differential; D004363:Drug Utilization / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D018410:Pneumonia, Bacterial / Q000145:classification / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology; D017410:Practice Guidelines as Topic / Q000592:standards*; D012720:Severity of Illness Index; D012737:Sex Factors
D000900:Anti-Bacterial Agents