RT Journal Article
SR Electronic
T1 Nursing and healthcare-associated pneumonia requiring hospital admission: Microbiology and clinical outcomes
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP P2482
VO 44
IS Suppl 58
A1 Nobuaki Mamesaya
A1 Hiromi Tomioka
A1 Shinichiro Nakao
A1 Reina Sekiya
A1 Shuji Yamashita
A1 Toshihiko Kaneda
A1 Yoko Kida
A1 Chihiro Nishio
A1 Masahiro Kaneko
YR 2014
UL http://erj.ersjournals.com/content/44/Suppl_58/P2482.abstract
AB 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.