title: Clinical efficacy of carbapenems on hospital-acquired pneumonia in accordance with the Japanese Respiratory Society Guidelines for management of HAP.
abstract: Hospital-acquired pneumonia (HAP) is the second most common cause of hospital-acquired infection and is the leading cause of death. In 2002, the Japanese Respiratory Society (JRS) published guidelines for the diagnosis and treatment of HAP (JRS GL 2002). In these guidelines, treatment with carbapenems is recommended for all disease types of HAP, excluding cases of mild or moderate pneumonia with no risk factors, and cases with early-onset ventilation-acquired pneumonia. To evaluate the efficacy of carbapenems on HAP in accordance with JRS GL 2002, we conducted a prospective study of HAP patients treated with carbapenems based on JRS GL 2002. The results of this study were also analyzed based on the revised guidelines published in June 2008 (JRS GL 2008), and the validity of the new guidelines was examined. Of the 33 subjects, 19 were judged as responders to the treatment, corresponding to a response rate of 57.6%. There were 3 deaths, corresponding to a mortality rate of 9.1%. The efficacy of carbapenems for the treatment of HAP based on JRS GL 2002 was confirmed. The severity rating system in JRS GL 2002 has a tendency to overestimate the severity of the cases and may lead to overtreatment in some cases. On the other hand, the severity rating system by JRS GL 2008 seemed to be more accurate and closely correlated with the efficacy of the treatment. It is suggested that JRS GL 2008 is more useful in clinical practice for accurately judging the severity of the disease and initiating appropriate subsequent antibiotic therapy.
authors.affiliation: Respiratory Disease Center, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama 232-0024, Japan.
authors.forename: Masaru
authors.initials: M
authors.lastname: Ito
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kaneko
authors.forename: Hideto
authors.initials: H
authors.lastname: Goto
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Yamaguchi
authors.forename: Shin
authors.initials: S
authors.lastname: Fujisawa
authors.forename: Shigeru
authors.initials: S
authors.lastname: Ono
authors.forename: Satoshi
authors.initials: S
authors.lastname: Morita
authors.forename: Naoki
authors.initials: N
authors.lastname: Miyazawa
authors.forename: Heiwa
authors.initials: H
authors.lastname: Kanamori
authors.forename: Yuji
authors.initials: Y
authors.lastname: Watanuki
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Ishigatsubo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D015780:Carbapenems / Q000627:therapeutic use*; D003428:Cross Infection / Q000188:drug therapy* / Q000382:microbiology; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D018410:Pneumonia, Bacterial / Q000188:drug therapy* / Q000382:microbiology; D017410:Practice Guidelines as Topic; D011379:Prognosis; D011446:Prospective Studies; D015203:Reproducibility of Results; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D015780:Carbapenems