Hospital-acquired pneumonia in general wards of a Japanese tertiary hospital

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Abstract
Hospital-acquired pneumonia (HAP) is an important nosocomial disorder because both its mortality and morbidity are high. The Japanese Respiratory Society (JRS) has proposed a new guideline for the diagnosis and treatment of HAP. Clinical investigations of HAP were conducted to assess the current status of HAP in accordance with this guideline. Inpatients who developed HAP in the Second Department of Internal Medicine, Nagasaki University Hospital, a tertiary hospital in Japan, were evaluated. The incidence of HAP was 1.86% (59 cases in 3176 admissions) from 1996 to 2000. In particular, the severity rating of HAP for 46 patients in accordance with the JRS guidelines, was assessed. The mortality rate was 6.5% at this hospital, which is less than that reported by other investigators in the field. The frequency of bacteria isolated from clinical specimens was as follows: Haemophilus influenzae (20%), Pseudomonas aeruginosa (16.7%), and methicillin-resistant Staphylococcus aureus (13.3%). Response rates were stratified by first-line medications and the results were as follows: penicillins (33.3%), third-generation cephems (44.4%), and carbapenems (66.7%). Based on the results presented here, the severity rating proposed in this guideline for HAP appears reasonable, as the response rate for the first-line antibiotic was better in Group II than in Groups III and IV. It will be important to analyse 'clinical outcome' in accordance with this guideline.