Clinical features of healthcare‐associated pneumonia (HCAP) in a Japanese community hospital: Comparisons among nursing home‐acquired pneumonia (NHAP), HCAP other than NHAP, and community‐acquired pneumonia

Umeki, Kenji; Tokimatsu, Issei; Yasuda, Chie; Iwata, Atsuko; Yoshioka, Daisuke; Ishii, Hiroshi; Shirai, Ryo; Kishi, Kenji; Hiramatsu, Kazufumi; Matsumoto, Bunroku; Kadota, Jun‐ichi

doi:10.1111/j.1440-1843.2011.01983.x

Cited by 52 publications

(43 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…These differences in clinical characteristics between the two hospitals might be because of differences in the proportion of elderly patients, the characteristics of each hospital and the local environment. In fact, Umeki et al demonstrated that the NHAP group was clinically different from the HCAP other than NHAP group, based on bacteriological examination and mortality rates (18). The present results also demonstrated that there were several differences in the clinical characteristics among the patients in NHCAP groups (Table 7).…”

Section: Discussionsupporting

confidence: 70%

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

et al. 2012

View full text Add to dashboard Cite

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. Conclusion 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.

show abstract

Section: Discussionsupporting

confidence: 70%

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

et al. 2012

View full text Add to dashboard Cite

show abstract

“…In fact, a retrospective study from Belgium identified NHAP (not HCAP) as the only subgroup independently associated with mortality [34]. Similarly, a small Japanese study found that NHAP differed from other groups included in HCAP: mortality was higher (11 vs. 0%) and MRSA was the leading pathogen [20]. ], hinting at performance status rather than etiologies as the reason behind increased mortality.…”

Section: Criteria For Healthcare-associated Pneumonia Definitionmentioning

confidence: 97%

“…Two studies from Japan report differences within HCAP. One reported that NHAP differs from O-HCAP (other HCAP criteria than NHAP) in terms of etiology and mortality [20]. The other study investigated hemodialysis-associated pneumonia.…”

Section: Criteria For Healthcare-associated Pneumonia Definitionmentioning

confidence: 98%

Is healthcare-associated pneumonia a distinct entity needing specific therapy?

Ewig¹,

Welte²,

Torres³

2012

Current Opinion in Infectious Diseases

View full text Add to dashboard Cite

The HCAP concept is based on varying definitions poorly predictive of MDR pathogens. The incidence of MDR pathogens is far lower than supposed in the original guideline document, and MDR pathogens do not seem to be the main cause of excess mortality. Broad antimicrobial coverage does not alter outcomes. As the HCAP concept results in a tremendous overtreatment without any evidence for improved outcomes, it should not be implemented in clinical practice prior to clear evidence that it is superior to a careful assessment of individual risk factors for MDR pathogens.

show abstract

“…5,9,10 According to the latest statistics, NH residents account for 10% to 18% of all patients hospitalized for pneumonia, with an average hospital charge of approximately $10,000 per admission. 5,9,10 According to the latest statistics, NH residents account for 10% to 18% of all patients hospitalized for pneumonia, with an average hospital charge of approximately $10,000 per admission.…”

Section: Nursing Home-associated Pneumoniamentioning

confidence: 99%

Hcap

Liapikou¹,

Polverino²,

Torres³

2014

Clinical Pulmonary Medicine

View full text Add to dashboard Cite

Health care-associated pneumonia (HCAP) includes a broad spectrum of patients who acquire pneumonia through outpatient contact with the health system. It has been suggested that HCAP merits a distinct therapeutic approach, because its epidemiology, causative organisms, and antibiotic susceptibilities may differ from those of community-acquired pneumonia, characterized by an excess of multidrug-resistant pathogens. HCAP was included in the 2005 American Thoracic Society/Infectious Diseases Society of America guidelines for nosocomial pneumonia, with the recommendation that all such patients receive empiric therapy with a multidrug antibiotic regimen. Over the last few years there has been a controversy over whether HCAP is associated with more frequent drug-resistant pathogens (not in Europe) and whether the higher mortality is due to inappropriate therapy or the poor functional status of the HCAP patients. Further studies have shown that therapy consistent with HCAP treatment guidelines has also not been found to improve mortality. The heterogeneity of the HCAP concept affords patients a different treatment approach based on assessment of individual risk factors for multidrug resistance pathogens, but does not seem to be confirmed on the basis of current evidence from the literature.

show abstract

Clinical features of healthcare‐associated pneumonia (HCAP) in a Japanese community hospital: Comparisons among nursing home‐acquired pneumonia (NHAP), HCAP other than NHAP, and community‐acquired pneumonia

Cited by 52 publications

References 18 publications

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

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

Is healthcare-associated pneumonia a distinct entity needing specific therapy?

Hcap

Contact Info

Product

Resources

About