title: Retrospective analysis of nursing and healthcare-associated pneumonia: analysis of adverse prognostic factors and validity of the selection criteria.
abstract: BACKGROUND
  Nursing and healthcare-associated pneumonia (NHCAP) is a relatively new condition that was recently defined by the Japanese Respiratory Society. Previous reports and guidelines have not thoroughly investigated the adverse prognostic factors and validity of the selection criteria for NHCAP. The purpose of this research was to clarify the adverse prognostic factors of NHCAP and investigate the validity of the selection criteria with respect to patient deaths.
  
  
  METHODS
  We retrospectively analyzed 418 patients with pneumonia who were admitted to our hospital between January 2009 and December 2011.
  
  
  RESULTS
  We analyzed 215 (51.4%) cases of community-acquired pneumonia (CAP) and 203 (48.6%) cases of NHCAP. NHCAP patients were generally older and had poorer performance status (PS), more complications, and higher levels of mortality than CAP patients. In both groups, the most common causative pathogen was Streptococcus pneumoniae. A multivariate analysis of NHCAP revealed that age ≥ 80 years, oxygen saturation (SpO2) ≤ 90%, and methicillin-resistant Staphylococcus aureus (MRSA) infection to be independent factors associated with mortality. Of the NHCAP selection criteria, a PS ≥ 3 and a hospitalization history within the past 90 days were adverse prognostic factors in the broad community-acquired pneumonia category (CAP+NHCAP), according to a multivariate analysis. Univariate analysis revealed that admission to an extended care facility or nursing home was associated with death.
  
  
  CONCLUSIONS
  Our results demonstrated that age ≥ 80 years, SpO2 ≤ 90%, and MRSA infection were adverse prognostic factors for NHCAP patients. Furthermore, we confirmed the validity of the NHCAP selection criteria.
authors.affiliation: Department of Respiratory Medicine, National Hospital Organization, Omuta National Hospital, 1044-1 Tachibana, Omuta-shi, Fukuoka 837-0911, Japan. Electronic address: sakoda-y@oomuta-h.com.
authors.forename: Yoritake
authors.initials: Y
authors.lastname: Sakoda
authors.affiliation: Department of Respiratory Medicine, National Hospital Organization, Omuta National Hospital, 1044-1 Tachibana, Omuta-shi, Fukuoka 837-0911, Japan. Electronic address: s-ikegame@mb4.seikyou.ne.jp.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Ikegame
authors.affiliation: Department of Respiratory Medicine, National Hospital Organization, Omuta National Hospital, 1044-1 Tachibana, Omuta-shi, Fukuoka 837-0911, Japan. Electronic address: harada-t@oomuta-h.com.
authors.forename: Chika
authors.initials: C
authors.lastname: Ikeda-Harada
authors.affiliation: Department of Respiratory Medicine, National Hospital Organization, Omuta National Hospital, 1044-1 Tachibana, Omuta-shi, Fukuoka 837-0911, Japan. Electronic address: takakura-k@oomuta-h.com.
authors.forename: Koji
authors.initials: K
authors.lastname: Takakura
authors.affiliation: Department of Respiratory Medicine, National Hospital Organization, Omuta National Hospital, 1044-1 Tachibana, Omuta-shi, Fukuoka 837-0911, Japan. Electronic address: kumazoe-h@oomuta-h.com.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kumazoe
authors.affiliation: Department of Respiratory Medicine, National Hospital Organization, Omuta National Hospital, 1044-1 Tachibana, Omuta-shi, Fukuoka 837-0911, Japan. Electronic address: wakamatsu-k@oomuta-h.com.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Wakamatsu
authors.affiliation: Research Institute for Diseases of the Chest, Faculty of Medicine, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan. Electronic address: yoichi@kokyu.med.kyushu-u.ac.jp.
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Nakanishi
authors.affiliation: Department of Respiratory Medicine, National Hospital Organization, Omuta National Hospital, 1044-1 Tachibana, Omuta-shi, Fukuoka 837-0911, Japan. Electronic address: kawasaki-m@oomuta-h.com.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Kawasaki
mesh_terms: D000367:Age Factors; D017714:Community-Acquired Infections / Q000382:microbiology / Q000401:mortality*; D003428:Cross Infection / Q000382:microbiology / Q000401:mortality*; D006760:Hospitalization; D055624:Methicillin-Resistant Staphylococcus aureus; D010100:Oxygen / Q000097:blood; D011014:Pneumonia / Q000382:microbiology / Q000401:mortality*; D011379:Prognosis; D012189:Retrospective Studies; D013203:Staphylococcal Infections; D013296:Streptococcus pneumoniae / Q000472:pathogenicity; D013997:Time Factors
chemical_list: D010100:Oxygen
keywords: A-DROP; Community-acquired pneumonia; Guideline; Methicillin-resistant Staphylococcus aureus; Nursing healthcare-associated pneumonia