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Abstract

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Article in Japanese

Original Article

Health-care-associated pneumonia, including cases that require nursing care based on walking ability

Sawa Shirai  Naoto Takase  Eriko Tabata  Shigeru Akutagawa  Shigeki Hashimoto 

Department of Respiratory Medicine, Ikeda City Hospital

ABSTRACT

Health-care-associated pneumonia (HCAP) is a new category that has been defined in the 2005 American Thoracic Society (ATS)/Infectious Disease Society of America (IDSA) guidelines. Readers should be aware of differences between the health-care systems of the United States and Japan and that new guidelines for nursing and health-care-associated pneumonia (NHCAP) were released in Japan in August 2011. We conducted a retrospective observational study of patients with pneumonia who were admitted to our hospital from April 2009 to March 2011. We compared these patients based on two criteria: patients with community-acquired pneumonia (CAP) and HCAP, and patients with “true CAP” and “nHCAP”. Subjects without walking ability were defined as those who needed nursing care. The CAP patients with walking ability were assigned to the true CAP group, and the HCAP patients without walking ability were assigned to the nHCAP group. Patients with HCAP were more likely to have severe pneumonia and die in the hospital than patients with CAP; however, the difference was not significant. In contrast, the proportion of patients in the severe category was significantly higher in the nHCAP patients than in the true CAP patients, and the hospital mortality rate in nHCAP patients was significantly greater than in true CAP patients. Streptococcus pneumoniae and Haemophilus influenzae were the most frequently isolated pathogens in the CAP and true CAP groups. Pseudomonas aeruginosa and methicillin-resistant Staphylococcus aureus were isolated more frequently in the HCAP and nHCAP groups than in the CAP and true CAP groups. We suggest that the concept of NHCAP is more useful than that of the HCAP group, such as in predicting prognosis. Further detailed investigations of NHCAP in different communities and institutions in Japan are required because the characteristics of subjects with NHCAP vary according to these factors.

KEYWORDS

HCAP  NHCAP  Nursing care  Ability to walk  pandrug-resistant pathogen 

Received 14 Nov 2011 / Accepted 9 Feb 2012

AJRS, 1(6): 451-457, 2012

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