title: Clinical features of healthcare-associated pneumonia (HCAP) in a Japanese community hospital: comparisons among nursing home-acquired pneumonia (NHAP), HCAP other than NHAP, and community-acquired pneumonia.
abstract: OBJECTIVE
  More than 100000 Japanese die of pneumonia every year. The number of people residing in nursing homes is increasing with the ageing of the population. In 2005, the American Thoracic Society/Infectious Diseases Society of America (ATS/IDSA) published important guidelines for the management of healthcare-associated pneumonia (HCAP). In Japan, however, the optimum strategy for management of HCAP is still unclear. The purpose of this study was to clarify the clinical features of patients with HCAP.
  
  
  METHODS
  Patients (n = 202) who were consecutively admitted with a diagnosis of acute pneumonia between October 2007 and September 2009 were retrospectively evaluated. Using the ATS/IDSA guidelines, patients were divided into three groups: a community-acquired pneumonia (CAP) group (n = 123), a nursing home-acquired pneumonia (NHAP) group (n = 46) and a HCAP other than NHAP (O-HCAP) group (n = 33). These groups were then compared with respect to laboratory data, microbiological findings and mortality.
  
  
  RESULTS
  Thirty-day mortality in the NHAP group (10.9%) tended to be higher than that in the CAP group (3.3%) or the O-HCAP group (0%). The pathogens most frequently identified were Streptococcus pneumoniae and Haemophilus influenzae in the CAP group, methicillin-resistant Staphylococcus aureus and Klebsiella pneumoniae in the NHAP group, and S. pneumoniae and K. pneumoniae in the O-HCAP group.
  
  
  CONCLUSIONS
  The NHAP group was clinically different from the O-HCAP group, based on bacteriological examination and mortality rates. In order to accurately diagnose, and formulate optimum treatment strategies for Japanese patients, the categories of HCAP, as specified in the ATS/IDSA guidelines, should not be applied directly either to patients with NHAP or those with O-HCAP.
authors.affiliation: Internal Medicine II, Oita University Faculty of Medicine, Yufu, Japan. umeken@oita-u.ac.jp
authors.forename: Kenji
authors.initials: K
authors.lastname: Umeki
authors.forename: Issei
authors.initials: I
authors.lastname: Tokimatsu
authors.forename: Chie
authors.initials: C
authors.lastname: Yasuda
authors.forename: Atsuko
authors.initials: A
authors.lastname: Iwata
authors.forename: Daisuke
authors.initials: D
authors.lastname: Yoshioka
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Ishii
authors.forename: Ryo
authors.initials: R
authors.lastname: Shirai
authors.forename: Kenji
authors.initials: K
authors.lastname: Kishi
authors.forename: Kazufumi
authors.initials: K
authors.lastname: Hiramatsu
authors.forename: Bunroku
authors.initials: B
authors.lastname: Matsumoto
authors.forename: Jun-Ichi
authors.initials: J
authors.lastname: Kadota
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D017714:Community-Acquired Infections / Q000453:epidemiology / Q000382:microbiology* / Q000401:mortality*; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology* / Q000401:mortality*; D005260:Female; D006193:Haemophilus influenzae / Q000302:isolation & purification; D006764:Hospitals, Community; D006801:Humans; D007564:Japan / Q000453:epidemiology; D007711:Klebsiella pneumoniae / Q000302:isolation & purification; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification; D008875:Middle Aged; D009735:Nursing Homes; D011014:Pneumonia / Q000453:epidemiology / Q000382:microbiology* / Q000401:mortality*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013183:Sputum / Q000382:microbiology; D013296:Streptococcus pneumoniae / Q000302:isolation & purification; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents