Abstract
Backgrounds:Guidelines suggest that patients with healthcare-associated pneumonia(HCAP)be treated empirically for multidrug-resistant(MDR)pathogens. However, potentially pathogenic bacteria may be merely colonizers.
The Japan Respiratory Society documented a new category, nursing and healthcare-associated pneumonia(NHCAP).Objectives:The objective of this study was to investigate the role of sputum cultures, and to clarify the strategy for treatment of NHCAP. Methods:We conducted a retrospective study of 408 patients with NHCAP who were hospitalized at a single center between 2010 and 2012. The criteria for NHCAP were:(1)residence in a nursing home or an extended-care ward,(2)a discharge from a hospital in the preceding 90 days,(3)an elderly or handicapped patient who needs long-term care,(4)a patient who regularly requires vascular access in an outpatient setting. Results:Median age; 82±11. The number of sputum samples evaluated for pathogens were 327(80.0%), which included 75(23%)acceptable specimens judged by the criteria of Geckler. The most common pathogens were Methicillin-susceptible Staphylococcus aureus (MSSA)(16%), followed by Pseudomonas aeruginosa(12%)and Methicillin-resistant Staphylococcus aureus(MRSA)(11%). The most frequently used antimicrobials were penicillins with beta-lactamase inhibitors. Eight of 18 patients in whom MDR pathogens were detected, resolved without anti-MDR antimicrobials.Conclusion:NHCAP patients often provided inadequate sputum samples. Distinguishing true pathogens from colonizers in clinical practice is challenging. Further studies should be performed to avoid the overuse of broad-spectrum antibiotics.
- © 2014 ERS
