title: Clinical features and the role of atypical pathogens in nursing and healthcare-associated pneumonia (NHCAP): differences between a teaching university hospital and a community hospital.
abstract: OBJECTIVE
  The Japan Respiratory Society documented a new category of guidelines for nursing and healthcare-associated pneumonia (NHCAP), which is distinct from community acquired pneumonia (CAP). The objective of this study was to determine the epidemiological differences between NHCAP patients in a teaching university hospital and a community hospital. In addition, to clarify the strategy for treatment of NHCAP, we investigated the role of atypical pathogens.
  
  
  METHODS
  We analyzed 250 NHCAP and 421 CAP cases in a university hospital and 349 NHCAP and 374 CAP cases in a community hospital.
  
  
  RESULTS
  Patient age and the incidences of poor general condition were significantly higher in the community hospital compared with those in the university hospital. The distribution and frequency of pathogens, especially multidrug-resistant (MDR) pathogens, were significantly different between the two hospitals. Central nervous system disorders, dementia and poor performance status, which was possibility related to aspiration pneumonia, were significantly more frequent in patients with NHCAP compared with those with CAP in both hospitals. Atypical pathogens were detected in a few cases in patients with NHCAP.
  
  
  CONCLUSIONS
  There were many differences in the clinical characteristics between NHCAP patients in a university hospital and a community hospital even for hospitals located in the same area. Aspiration pneumonia was thought to be the main characteristic of NHCAP in both hospitals. Thus, all NHCAP patients did not need the same empiric therapy with a multidrug regimen directed against MDR pathogens. In addition, physicians rarely need to consider atypical pathogens in NHCAP treatment.
authors.affiliation: Department of Internal Medicine I, Kawasaki Medical School, Japan. nao@med.kawasaki-m.ac.jp
authors.forename: Naoyuki
authors.initials: N
authors.lastname: Miyashita
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Kawai
authors.forename: Hiroto
authors.initials: H
authors.lastname: Akaike
authors.forename: Kazunobu
authors.initials: K
authors.lastname: Ouchi
authors.forename: Toshikiyo
authors.initials: T
authors.lastname: Hayashi
authors.forename: Takeyuki
authors.initials: T
authors.lastname: Kurihara
authors.forename: Niro
authors.initials: N
authors.lastname: Okimoto
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D061387:Chlamydial Pneumonia / Q000453:epidemiology / Q000382:microbiology; D016993:Chlamydophila pneumoniae / Q000302:isolation & purification; D002691:Chlamydophila psittaci / Q000302:isolation & purification; D015897:Comorbidity; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology; D003953:Diagnosis-Related Groups; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D006090:Gram-Negative Bacteria / Q000187:drug effects / Q000302:isolation & purification*; D016905:Gram-Negative Bacterial Infections / Q000453:epidemiology* / Q000382:microbiology; D006094:Gram-Positive Bacteria / Q000187:drug effects / Q000302:isolation & purification*; D016908:Gram-Positive Bacterial Infections / Q000453:epidemiology* / Q000382:microbiology; D006764:Hospitals, Community / Q000706:statistics & numerical data*; D006784:Hospitals, Teaching / Q000706:statistics & numerical data*; D006801:Humans; D007564:Japan / Q000453:epidemiology; D007877:Legionnaires' Disease / Q000453:epidemiology / Q000382:microbiology; D008297:Male; D008875:Middle Aged; D018410:Pneumonia, Bacterial / Q000453:epidemiology* / Q000382:microbiology; D011019:Pneumonia, Mycoplasma / Q000453:epidemiology / Q000382:microbiology; D012720:Severity of Illness Index; D016896:Treatment Outcome