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Can the broad-spectrum antibiotics improve the prognoses of high-risk nursing- and healthcare-associated pneumonia?

Kenji Umeki, Kosaku Komiya, Eri Mizukami, Hisako Kushima, Satosi Toba, Masaru Ando, Shinichi Nureki, Issei Tokimatsu, Kazufumi Hiramatsu, Junichi Kadota
European Respiratory Journal 2014 44: P2478; DOI:
Kenji Umeki
1Department of Respiratory Medicine and Infectious Diseases, Oita University Faculty of Medicine, Yufu, Oita, Japan
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Kosaku Komiya
2Clinical Research Center of Respiratory Medicine, Tenshindo Hetsugi Hospital, Oita, Japan
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Eri Mizukami
1Department of Respiratory Medicine and Infectious Diseases, Oita University Faculty of Medicine, Yufu, Oita, Japan
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Hisako Kushima
1Department of Respiratory Medicine and Infectious Diseases, Oita University Faculty of Medicine, Yufu, Oita, Japan
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Satosi Toba
1Department of Respiratory Medicine and Infectious Diseases, Oita University Faculty of Medicine, Yufu, Oita, Japan
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Masaru Ando
1Department of Respiratory Medicine and Infectious Diseases, Oita University Faculty of Medicine, Yufu, Oita, Japan
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Shinichi Nureki
1Department of Respiratory Medicine and Infectious Diseases, Oita University Faculty of Medicine, Yufu, Oita, Japan
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Issei Tokimatsu
1Department of Respiratory Medicine and Infectious Diseases, Oita University Faculty of Medicine, Yufu, Oita, Japan
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Kazufumi Hiramatsu
1Department of Respiratory Medicine and Infectious Diseases, Oita University Faculty of Medicine, Yufu, Oita, Japan
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Junichi Kadota
1Department of Respiratory Medicine and Infectious Diseases, Oita University Faculty of Medicine, Yufu, Oita, Japan
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Abstract

Background and aim: Nursing- and healthcare-associated pneumonia (NHCAP) is a new concept, proposed by the Japanese Respiratory Society in 2011 (Kohno S, et al. Respir Investig 2013; 51:103-126). It is a modification of the healthcare-associated pneumonia described for the US to more accurately reflect the situation in Japan. The optimal treatments for NHCAP are still unclear. Although NHCAP patients often have drug-resistant pathogens, it has been reported that the outcomes do not depend on the antibiotics administered, but on the status of the patients. To evaluate the contribution of the broad-spectrum antibiotics for high-risk NHCAP, we examined the admitted NHCAP patients.

Methods: We retrospectively examined 172 patients who met the NHCAP criteria and the definition of high-risk pneumonia. The criteria for NHCAP were as described in the NHCAP guidelines. The definition of high-risk was a severe or very severe classification, or a Performance status of 3 or 4. We divided the high-risk patients into two groups. In the Narrow group, patients were treated with narrow-spectrum antibiotics, while the patients treated with broad-spectrum antibiotics were included in the Broad group. The patient survival was analyzed using Kaplan-Meier curves and the log-rank test.

Results: There were 127 in the Narrow group and 45 in the Broad group. The 30-day mortality rates were 12.6% and 24.4%, respectively. Although the difference was not significant, the survival rate of the Narrow group tended to be higher than that of the Broad group (p = 0.08).

Conclusions: We herein demonstrated that broad-spectrum antibiotics did not improve the prognoses of high-risk NHCAP patients.

  • Pneumonia
  • Bacteria
  • End of life
  • © 2014 ERS
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Can the broad-spectrum antibiotics improve the prognoses of high-risk nursing- and healthcare-associated pneumonia?
Kenji Umeki, Kosaku Komiya, Eri Mizukami, Hisako Kushima, Satosi Toba, Masaru Ando, Shinichi Nureki, Issei Tokimatsu, Kazufumi Hiramatsu, Junichi Kadota
European Respiratory Journal Sep 2014, 44 (Suppl 58) P2478;

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Can the broad-spectrum antibiotics improve the prognoses of high-risk nursing- and healthcare-associated pneumonia?
Kenji Umeki, Kosaku Komiya, Eri Mizukami, Hisako Kushima, Satosi Toba, Masaru Ando, Shinichi Nureki, Issei Tokimatsu, Kazufumi Hiramatsu, Junichi Kadota
European Respiratory Journal Sep 2014, 44 (Suppl 58) P2478;
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