title: Clinical characteristics of nursing and healthcare-associated pneumonia: a Japanese variant of healthcare-associated pneumonia.
abstract: OBJECTIVE
  The aim of this study was to describe the epidemiology, clinical features, antimicrobial treatment, and outcomes of patients with nursing and healthcare-associated pneumonia (NHCAP); a new category of pneumonia proposed by the Japanese Respiratory Society.
  
  
  METHODS
  We conducted a retrospective analysis of a prospectively collected database of patients with NHCAP and community-acquired pneumonia (CAP) hospitalized at a single center between January 2008 and December 2010, and compared their clinical characteristics. The criteria for NHCAP were as follows: (1) residence in a nursing home or an extended-care ward, (2) a discharge from a hospital in the preceding 90 days, (3) an elderly or handicapped patient who needs long-term care, (4) a patient who regularly requires vascular access in an outpatient setting.
  
  
  RESULTS
  A total of 442 NHCAP patients and 451 CAP patients were evaluated. The NHCAP patients were older and had a higher frequency of underlying diseases. Aspiration was thought to be associated with the NHCAP in 63% of patients. Streptococcus pneumoniae was the leading pathogen in both groups, whereas the frequency of multidrug-resistant pathogens was higher in the NHCAP patients. The most frequently used antimicrobials in NHCAP patients were penicillins with beta-lactamase inhibitors. The in-hospital mortality and recurrence rates were significantly higher in NHCAP patients than in CAP patients (13.1% vs. 5.1%, p<0.001 and 18.8% vs. 5.5%, p<0.001).
  
  
  CONCLUSIONS
  The clinical picture of NHCAP is consistent with that of HCAP described in the past. It is thought to be of benefit to modify the healthcare-associated pneumonia (HCAP) criteria considering the healthcare and social health insurance system in Japan.
authors.affiliation: Department of Respiratory Medicine, Kurashiki Central Hospital, Japan. ishidat@kchnet.or.jp
authors.forename: Tadashi
authors.initials: T
authors.lastname: Ishida
authors.forename: Hiromasa
authors.initials: H
authors.lastname: Tachibana
authors.forename: Akihiro
authors.initials: A
authors.lastname: Ito
authors.forename: Hiroshige
authors.initials: H
authors.lastname: Yoshioka
authors.forename: Machiko
authors.initials: M
authors.lastname: Arita
authors.forename: Toru
authors.initials: T
authors.lastname: Hashimoto
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data; D000890:Anti-Infective Agents / Q000627:therapeutic use; D017714:Community-Acquired Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000635:transmission*; D003428:Cross Infection / Q000188:drug therapy / Q000453:epidemiology* / Q000635:transmission*; D005260:Female; D006306:Health Surveys; D006801:Humans; D017757:Infectious Disease Transmission, Professional-to-Patient / Q000706:statistics & numerical data*; D007564:Japan / Q000453:epidemiology; D008134:Long-Term Care / Q000706:statistics & numerical data; D008297:Male; D009735:Nursing Homes / Q000706:statistics & numerical data; D010351:Patient Discharge / Q000706:statistics & numerical data; D011014:Pneumonia / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology*; D011446:Prospective Studies; D012189:Retrospective Studies; D013296:Streptococcus pneumoniae / Q000472:pathogenicity; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000890:Anti-Infective Agents