The Journal of Medical Investigation
Online ISSN : 1349-6867
Print ISSN : 1343-1420
ISSN-L : 1343-1420
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Difference of health-care associated pneumonia between large hospitals and small hospitals in Japan
Masanari Watanabe, Kazuhiro Kato, Kenichi Takeda, Tatsuya Konishi, Jun Kurai, Toshiyuki Tatsukawa, Hiroyuki Yamamoto, Yoshisato Tamura, Soichiro Ishikawa, Yuji Kawasaki, Masato Morita, Kazuhiko Yoneda, Hidechika Fujise, Yuki Fujise, Kazuomi Fujise, Kosuke Yamaguchi, Tatsuya Hayabuchi, Keji Shigeshiro, Satoru Katayama, Hiroki Chikumi, Tadashi Igishi, Akira Yamasaki, Yasuyuki Hasegawa, Ryota Okazaki, Naoto Burioka, Eiji Shimizu
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Keywords: pneumonia, severity, mortality, pathogens
JOURNAL FREE ACCESS

2011 Volume 58 Issue 1,2 Pages 67-74

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Abstract

Objective: Health-care associated pneumonia (HCAP) is a new category of pneumonia. We investigated differences of epidemiology, pathogens, and outcomes between HCAP patients in large hospitals and those in small hospitals. Methods: This was a retrospective observational study of patients hospitalized with HCAP from December 2009 to March 2010. HCAP was defined according to ATS/IDSA criteria. A large hospital was defined as ≥200 beds and a small hospital was <200 beds. Results: Of 117 patients, 61 patients were admitted to large hospitals and 56 patients were admitted to small hospitals. There was a significant difference of HCAP diagnostic criteria between the two groups. The A-DROP severity class was worse in the large hospital group than the small hospital group (P<0.05). Respiratory failure and disturbance of consciousness were more frequent in the large hospital group (P<0.05). The mortality rate was 8.2% in the large hospital group versus 1.8% in the small hospital group. Patients in the very severe A-DROP class had a high mortality rate of 33% in both groups. Conclusion: Patients with severe HCAP were more likely to be admitted to large hospitals. Patients in the very severe A-DROP class should receive intensive antibiotic therapy, but not all patients need broad-spectrum therapy. J. Med. Invest. 58: 67-74, February, 2011

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© 2011 by The University of Tokushima Faculty of Medicine
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