Difference of health-care associated pneumonia between large hospitals and small hospitals in Japan

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.

The journal of medical investigation : http://medical.med.tokushima-u.ac.jp/jmi/index.html