Hospital-acquired pneumonia in general wards of a Japanese tertiary hospital.
OBJECTIVE
Hospital-acquired pneumonia (HAP) is an important nosocomial disorder because both its mortality and morbidity are high. The Japanese Respiratory Society (JRS) has proposed a new guideline for the diagnosis and treatment of HAP. Clinical investigations of HAP were conducted to assess the current status of HAP in accordance with this guideline.


METHODS
Inpatients who developed HAP in the Second Department of Internal Medicine, Nagasaki University Hospital, a tertiary hospital in Japan, were evaluated. The incidence of HAP was 1.86% (59 cases in 3176 admissions) from 1996 to 2000. In particular, the severity rating of HAP for 46 patients in accordance with the JRS guidelines, was assessed.


RESULTS
The mortality rate was 6.5% at this hospital, which is less than that reported by other investigators in the field. The frequency of bacteria isolated from clinical specimens was as follows: Haemophilus influenzae (20%), Pseudomonas aeruginosa (16.7%), and methicillin-resistant Staphylococcus aureus (13.3%). Response rates were stratified by first-line medications and the results were as follows: penicillins (33.3%), third-generation cephems (44.4%), and carbapenems (66.7%).


CONCLUSIONS
Based on the results presented here, the severity rating proposed in this guideline for HAP appears reasonable, as the response rate for the first-line antibiotic was better in Group II than in Groups III and IV. It will be important to analyse 'clinical outcome' in accordance with this guideline.
Second Department of Internal Medicine, Nagasaki University Graduate School of Pharmaceutical Sciences, Sakamoto, Nagasaki, Japan.
Hideo
H
Ohi
Katsunori
K
Yanagihara
Yoshitsugu
Y
Miyazaki
Yoichi
Y
Hirakata
Kazunori
K
Tomono
Jun-ichi
J
Kadota
Takayoshi
T
Tashiro
Shigeru
S
Kohno
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003428:Cross Infection / Q000453:epidemiology*; D006193:Haemophilus influenzae / Q000302:isolation & purification; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008875:Middle Aged; D010362:Patients' Rooms; D011014:Pneumonia / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology
D000900:Anti-Bacterial Agents