361. Hospital Acquired Pneumonia in Japan may have better mortality profile than HAP in the United States. A Retrospective study
Session: Poster Abstract Session: Community and Healthcare Acquired Pneumonia - Epidemiology
Friday, October 21, 2011
Room: Poster Hall B1
Handouts
  • idsaslide2011.latest.png (340.4 kB)
  • Background: Hospital-acquired pneumonia (HAP) is associated with significant morbidity and mortality. However, characteristics of HAP in Japan are not well studied. We investigated characteristics of culture confirmed HAP in a Japanese hospital, such as severity and mortality, microbiology profile, and the value of Gram staining.

    Methods: This is a single-center retrospective review at a Japanese University Hospital. Only positive sputum culture cases with Geckler classification of 4 or 5 by microscopic appearance were included to the analysis. Data were collected from April 1, 2008 to May 15, 2009. Clinical characteristics as well as the characteristics of causative organisms were investigated. Value of prediction rules used in community acquired pneumonia (CAP), such as PSI, CURB-65, and SMART-COP, as well as the rule proposed for HAP by Japanese Respiratory Society (JRS) were evaluated for prediction of mortality.

    Results: Among 3465 specimens, 42 cases were included to the analysis. Mean age of the patients were 67.1 years old (18.3) and 33 were male (78.6%). 26 (61.9%) occurred in Intensive Care Unit (ICU), and 17 (40.5%) were ventilator-associated pneumonia (VAP). Late-onset HAP (HAP occurring >4 days after hospitalization) was seen in 34 cases (81,0%). 30-day mortality was 23.8%, much less than reported in U.S. (30-70%). Age, sex, being in ICU, VAP, and late onset HAP, and any particular organism were not associated with higher mortality. Most common causative organisms were methicillin resistant Staphylococus aureus (MRSA) (34.0%) followed by Pseudomonas aeruginosa (19.1%). Sensitivity of Gram staining was 87.2%. It was 81.3% for MRSA and 77.8% for P. aeruginosa. SMART-COP predicted 30-day mortality with area under ROC curve >0.7.

    Conclusion: Characteristics of HAP in Japan is different from one in USA. Mortality is lower, with less ICU cases and less VAP. Factors known to be associated with worse outcome in USA did not appear to influence mortality of HAP in Japan. Gram staining of good quality specimens had relatively good sensitivity to predict causative organisms. Current prediction rules for both CAP and HAP were able to predict mortality only moderately. Better prediction rule for HAP in this setting needs to be developed.


    Subject Category: C. Clinical studies of bacterial infections and antibacterials including sexually transmitted diseases and mycobacterial infections (surveys, epidemiology, and clinical trials)

    Kentaro Iwata, MD1, Wataru Igarashi2, Midori Honjo3, Hideaki Oka4, Yuichiro Oba5, Hiroyuki Yoshida5, Goh Ohji, MD, PhD, DTM&H6 and Toshihiko Shimada7, (1)Division of Infectious Diseases Therapeutics, Department of Microbiology and Infectious Diseases, Kobe University Graduate School of Medicine, Kobe, Japan, (2)Division of Infectious Diseases, Kobe University Hospital, Kobe, Japan, (3)accerise Inc., Yoyogi, Japan, (4)Kanto Rosai Hospital, Kawasaki, Japan, (5)Kobe University Hospital, Kobe, Japan, (6)Division of Infectious Diseases Therapeutics, Department of Microbiology and Infectious Diseases, Kobe University Graduate School of Medicine, Kobe City, Hyogo, Japan, (7)Dept.of General Internal Medicine, Rakuwakai Otowa Hospital, Kyoto, Japan

    Disclosures:

    K. Iwata, None

    W. Igarashi, None

    M. Honjo, None

    H. Oka, None

    Y. Oba, None

    H. Yoshida, None

    G. Ohji, None

    T. Shimada, None

    Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.