Division of Infectious Diseases, Kobe University Hospital, Kobe, Japan.
J Infect Chemother. 2012 Oct;18(5):734-40. doi: 10.1007/s10156-012-0411-x. Epub 2012 Apr 11.
The characteristics of hospital-acquired pneumonia (HAP) are not well documented. In the present study we investigated the severity and mortality, microbiological profile, and the value of Gram staining in culture-confirmed HAP in a Japanese hospital by retrospective review conducted at a Japanese university hospital. Only culture-confirmed cases with good specimen quality were included in the analysis. The clinical characteristics of HAP, as well as the causative organisms, were investigated. Furthermore, the prognostic ability of existing prediction rules were evaluated for prediction of overall mortality. Forty-two cases were enrolled in this analysis. The majority of patients were admitted to the ICU (61.9 %), and 40.5 % had ventilator-associated pneumonia (VAP). The 30-day mortality was 23.8 %, which is less than that reported in the United States. Factors commonly known to be associated with worse outcome in the USA did not appear to influence the mortality from HAP in Japan. The most frequent causative organisms were methicillin-resistant Staphylococcus aureus (MRSA), followed by Pseudomonas spp. Sensitivity and negative predictive value of Gram staining were 89.4 and 85.7 %, respectively. SMART-COP predicted 30-day mortality with an area under the ROC curve (AUC) >0.7. The characteristics of HAP in Japan differ from HAP reported in the USA. In addition to lower mortality, we found both fewer ICU cases and VAP. Gram staining of good-quality specimens demonstrated promising sensitivity to predict the causative organisms. SMART-COP predicted mortality with appropriate ROC curve (AUC).
医院获得性肺炎（HAP）的特征尚未得到充分记录。在本研究中，我们通过对日本一家大学医院进行回顾性调查，研究了日本医院中经过培养证实的 HAP 的严重程度和死亡率、微生物特征以及革兰氏染色在培养中的价值。只有标本质量良好的培养证实病例才被纳入分析。我们调查了 HAP 的临床特征以及病原体。此外，还评估了现有预测规则对总体死亡率预测的预后能力。这项分析共纳入了 42 例病例。大多数患者被收入 ICU（61.9%），40.5%患有呼吸机相关性肺炎（VAP）。30 天死亡率为 23.8%，低于美国的报告。在美国，与预后不良相关的常见因素似乎并未影响日本 HAP 的死亡率。最常见的病原体是耐甲氧西林金黄色葡萄球菌（MRSA），其次是假单胞菌属。革兰氏染色的敏感性和阴性预测值分别为 89.4%和 85.7%。SMART-COP 对 30 天死亡率的预测曲线下面积（AUC）>0.7。日本 HAP 的特征与美国报道的 HAP 不同。除了死亡率较低外，我们还发现 ICU 病例和 VAP 较少。高质量标本的革兰氏染色显示出有希望的敏感性，可预测病原体。SMART-COP 对死亡率的预测具有适当的 ROC 曲线（AUC）。
