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

Objective:  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. Methodology:  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. Results:  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%). Conclusions:  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.