PURPOSE: The detection of pathogens of pneumonia staying in nursing-care facilities, severity, duration of hospitalization, mortality, and response rate to antibiotics were investigated.
METHODS: The subjects were56 patients who developed pneumonia staying in nursing-care facilities admitted to our hospital between May 2008 and April 2009. Pathogen detected in sputum, therapeutic drugs and the response, severity based on the CAP and HAP treatment guidelines of Japanese Respiratory Society, mortality by severity, and duration of hospitalization were retrospectively investigated.
RESULTS: Pathogens were detected in 27 cases(34 strains) were identified by sputum culture (MRSA in 9 cases, MSSA in 8, K.pneumonia in 4,Enterobacter spp. in 4, P.aeruginosa in 2, H.influenzae in 2, Serratia spp. in 3, and 3 others). The severity was mild, moderate, severe, and extremely severe in 0%, 60.7%, 25.0%, and 14.3% regarding the CAP severity classification, respctively, wherea it was mild, moderate, and severe in 42.9%, 17.9%, and 39.3% on the HAP severity classicication, respectively. The mortality by CAP severity was 17.6, 14.3, and 50% in the moderate, severe, and extremely severe cases, respectively. By HAP severity, the mortality was 4.2, 30, 36.4% in the mild, moderate, and severe cases, sepectively.No tendency was noted in the relationship between the severity and duration of hospitalization. The most frequently administered antibiotics in early treatment was drip infusion of SBT/ABPC alone in 77%.Eleven and 7 of 18 cases judged severe on either CAP or HAP severity classification were treated by SBT/ABPC alone and broad spectrum antibiotics, respectively.The response rates and mortality rates were 54.5% and 18% in the former, while 43% and 29% in the latter, respectively.
CONCLUSION: The detection frequencies of MRSA and MSSA were similar with repoted cases of HCAP in the U.S.A., that of P.aeruginosa was lower at our hospital. No tendency was noted regarding the relationship between the severity and duration of hospitalization, but the mortality rates was high in moderate and severe cases on the HAP severity classification.
CLINICAL IMPLICATIONS: SBT/ABPC was useful regardless of severity in our cases.
DISCLOSURE: Tadashi Takao, No Financial Disclosure Information; No Product/Research Disclosure Information