Difference of health-care associated pneumonia between large hospitals and small hospitals in Japan

• Published in: The Journal of Medical Investigation Vol. 58; no. 1,2; pp. 67 - 74
• Main Authors: Watanabe, Masanari, Kato, Kazuhiro, Takeda, Kenichi, Konishi, Tatsuya, Kurai, Jun, Tatsukawa, Toshiyuki, Yamamoto, Hiroyuki, Tamura, Yoshisato, Ishikawa, Soichiro, Kawasaki, Yuji, Morita, Masato, Yoneda, Kazuhiko, Fujise, Hidechika, Fujise, Yuki, Fujise, Kazuomi, Yamaguchi, Kosuke, Hayabuchi, Tatsuya, Shigeshiro, Keji, Katayama, Satoru, Chikumi, Hiroki, Igishi, Tadashi, Yamasaki, Akira, Hasegawa, Yasuyuki, Okazaki, Ryota, Burioka, Naoto, Shimizu, Eiji
• Format: Journal Article
• Language: English
• Published: Japan The University of Tokushima Faculty of Medicine 2011
• Subjects: Aged; Aged, 80 and over; Cross Infection - epidemiology; Cross Infection - microbiology; Cross Infection - mortality; Female; Hospital Bed Capacity; Hospitals - classification; Humans; Japan - epidemiology; Male; mortality; pathogens; pneumonia; Pneumonia - epidemiology; Pneumonia - microbiology; Pneumonia - mortality; severity; Japan
• ISSN: 1343-1420; 1349-6867
• DOI: 10.2152/jmi.58.67

Objective: Health-care associated pneumonia (HCAP) is a new category of pneumonia. We investigated differences of epidemiology, pathogens, and outcomes between HCAP patients in large hospitals and those in small hospitals. Methods: This was a retrospective observational study of patients hospitalized with HCAP from December 2009 to March 2010. HCAP was defined according to ATS/IDSA criteria. A large hospital was defined as ≥200 beds and a small hospital was <200 beds. Results: Of 117 patients, 61 patients were admitted to large hospitals and 56 patients were admitted to small hospitals. There was a significant difference of HCAP diagnostic criteria between the two groups. The A-DROP severity class was worse in the large hospital group than the small hospital group (P<0.05). Respiratory failure and disturbance of consciousness were more frequent in the large hospital group (P<0.05). The mortality rate was 8.2% in the large hospital group versus 1.8% in the small hospital group. Patients in the very severe A-DROP class had a high mortality rate of 33% in both groups. Conclusion: Patients with severe HCAP were more likely to be admitted to large hospitals. Patients in the very severe A-DROP class should receive intensive antibiotic therapy, but not all patients need broad-spectrum therapy. J. Med. Invest. 58: 67-74, February, 2011