title: Health-care-associated pneumonia among hospitalized patients in a Japanese community hospital.
abstract: BACKGROUND
  Health-care-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 (ie, age, dehydration, respiratory failure, orientation disturbance, and low BP), we investigated the in-hospital mortality and occurrence of potentially drug-resistant (PDR) pathogens.
  
  
  RESULTS
  A total of 371 patients (141 HCAP patients, 230 CAP patients) were evaluated. The proportion of patients in the severe class was higher in the HCAP patients than in CAP patients. In the moderate class, the in-hospital mortality proportion of HCAP patients was significantly higher than that of CAP patients (11.1% vs 1.9%, respectively; p = 0.008). In moderate-class patients in whom pathogens were identified, PDR pathogens were isolated more frequently from HCAP patients than from CAP patients (22.2% vs 1.9%, respectively; 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.
authors.affiliation: Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan. Electronic address: yshindo@med.nagoya-u.ac.jp.
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Shindo
authors.affiliation: Department of Respiratory Medicine, Handa City Hospital, Aichi, Japan.
authors.forename: Shinji
authors.initials: S
authors.lastname: Sato
authors.affiliation: Department of Respiratory Medicine, Handa City Hospital, Aichi, Japan.
authors.forename: Eiichi
authors.initials: E
authors.lastname: Maruyama
authors.affiliation: Department of Respiratory Medicine, Handa City Hospital, Aichi, Japan.
authors.forename: Takamasa
authors.initials: T
authors.lastname: Ohashi
authors.affiliation: Department of Respiratory Medicine, Handa City Hospital, Aichi, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Ogawa
authors.affiliation: Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan.
authors.forename: Naozumi
authors.initials: N
authors.lastname: Hashimoto
authors.affiliation: Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan.
authors.forename: Kazuyoshi
authors.initials: K
authors.lastname: Imaizumi
authors.affiliation: Department of Biostatistics, Kyoto University School of Public Health, Kyoto, Japan.
authors.forename: Tosiya
authors.initials: T
authors.lastname: Sato
authors.affiliation: Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan.
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Hasegawa
mesh_terms: D000368:Aged; D017714:Community-Acquired Infections; D003428:Cross Infection / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology* / Q000401:mortality; D005260:Female; D018575:Home Care Services, Hospital-Based; D017052:Hospital Mortality; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D009735:Nursing Homes; D018410:Pneumonia, Bacterial / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology* / Q000401:mortality; D012307:Risk Factors; D012720:Severity of Illness Index; D012866:Skilled Nursing Facilities; D017211:Treatment Failure